Emergence of a R-type Ca²+ channel (Cav 2.3) contributes to cerebral artery constriction following subarachnoid hemorrhage

ABSTRACT

The invention relates to methods and products for treatment of a neurological defect such as a subarachnoid hemorrhage or cerebral vasospasm. Specifically, R-type voltage-gated calcium channel inhibitors and related compositions and kits are described.

RELATED APPLICATIONS

This application claims priority under 35 U.S.C. §119(e) to U.S.Provisional Application Ser. No. 60/649,394, filed Feb. 2, 2005, andentitled “EMERGENCE OF A R-TYPE Ca²⁺ CHANNEL (Ca_(v) 2.3) CONTRIBUTES TOCEREBRAL ARTERY CONSTRICTION FOLLOWING SUBARACHNOID HEMORRHAGE”, thecontents of which are herein incorporated by reference in theirentirety.

FEDERALLY SPONSORED RESEARCH

This invention was made with Government support under NIH grant numberP20 RR16435 and NHLBI, R01 HL078983. Accordingly, the Government mayhave certain rights in this invention.

FIELD OF THE INVENTION

The present invention relates to voltage-gated calcium channelinhibitors, such as R- and L-type voltage-gated calcium channelinhibitors, compositions and kits thereof and methods for the use ofvoltage-gated calcium channel inhibitors in the treatment of diseasessuch as cerebral vasospasm.

BACKGROUND OF THE INVENTION

Cerebral aneurysm rupture and subarachnoid hemorrhage (SAH) inflictdisability and death upon thousands of individuals each year. Theconsequences of subarachnoid hemorrhage (SAH) following cerebralaneurysm rupture are devastating, with mortality rates as high as 50%and the majority of survivors left with moderate to severe disability(Hop J W, Rinkel G J, Algra A, van Gijn J. Case-fatality rates andfunctional outcome after subarachnoid hemorrhage: a systematic review.Stroke. 1997;28:660-664). Cerebral vasospasm, characterized as a delayedand sustained arterial constriction, is a major contributor to thesehigh morbidity and mortality rates associated with SAH and currenttherapies in the treatment of this phenomenon are less than ideal(Dietrich H H, Dacey R G, Jr. Molecular keys to the problems of cerebralvasospasm. Neurosurgery. 2000;46:517-530; Macdonald R L, Weir B K. Areview of hemoglobin and the pathogenesis of cerebral vasospasm. Stroke.1991;22:971-982; Treggiari-Venzi M M, Suter P M, Romand J A. Review ofmedical prevention of vasospasm after aneurysmal subarachnoidhemorrhage: a problem of neurointensive care. Neurosurgery.2001;48:249-261.). In addition to vasospasm in large diameter arteries,enhanced constriction of resistance arteries within the cerebralvasculature may contribute to decreased cerebral blood flow and thedevelopment of delayed neurological deficits following SAH. Classically,cerebral vasospasm has been diagnosed in SAH patients by the use ofangiography to detect cerebral artery narrowing.

In vitro, elevation of intravascular pressure within a physiologicalrange (60 to 100 mmHg) constricts small diameter cerebral arteries inthe absence of other vasoactive stimuli. In cerebral arteries fromhealthy animals, increased intravascular pressure leads to vascularsmooth muscle membrane potential depolarization and increased globalcytosolic free Ca²⁺ concentration ([Ca²⁺]_(i)) due to an increase in theopen-state probability of L-type voltage-dependent Ca²⁺ channels (VDCCs)(Brayden J E, Wellman G C. J Cereb Blood Flow Metab. 1989;9:256-263;Harder D R. Circ Res. 1984;55:197-202; Knot H J, et. al., J Physiol(Lond). 1998;508: 199-209.). L-type VDCC antagonists cause a maximaldecrease in [Ca²⁺]_(i) and abolish pressure- and agonist-inducedconstriction in small diameter arteries (Knot H J, et. al., J Physiol(Lond). 1998;508: 199-209; Gokina N I, Knot H J, Nelson M T, Osol G. AmJ Physiol. 1999;277:H1178-H1188; Hill M A, et. al., J Appl Physiol. 2001;91:973-983.). While L-type Ca²⁺ channels are widely accepted to be thedominant type of voltage-dependent Ca²⁺ channels expressed in arterialmyocytes, studies have also reported the presence of T-type (Chen C C,et. al., Science. 2003;302:1416-1418; Hansen P B, et. al., Circ Res.2001;89:630-638.), P/Q-type (Hansen P B, et. al., Circ Res.2000;87:896-902) and nifedipine-resistant high voltage-activated Ca²⁺Channels (Itonaga Y, et. al., Life Sci. 2002;72:487-500; Morita H, et.al., Circ Res. 1999;85:596-605; Simard J M. Pflugers Arch.1991;417:528-536.). Expression of L-type Ca²⁺ channels in vascularsmooth muscle has been reported to change both during development (BloodA B, et. al., Am J Physiol Regul Integr Comp Physiol. 2002;282:R131-R13)and hypertension (Pratt P F, et. al., Hypertension. 2002;40:214-219.).

SUMMARY OF THE INVENTION

One aspect of the invention is a method for treating cerebral vasospasmby administering to a subject an effective amount for treating cerebralvasospasm of a R-type voltage-dependent calcium channel inhibitor.

In one embodiment of the invention the R-type voltage-dependent calciumchannel inhibitor is administered to a subject in conjunction with anL-type voltage-dependent calcium channel inhibitor. In some embodimentsthe L-type voltage dependent calcium channel inhibitor is an antisenseoligonucleotide.

In another embodiment of the invention, the R-type voltage-dependentcalcium channel inhibitor is administered within 96 hours aftersubarachnoid hemorrhage has occurred. In still another embodiment, theR-type voltage-dependent calcium channel inhibitor is administeredwithin 1 week after subarachnoid hemorrhage has occurred. In yet anotherembodiment, the R-type voltage-dependent calcium channel inhibitor isadministered during surgery to treat subarachnoid hemorrhage. In anotherembodiment of the invention, the R-type voltage-dependent calciumchannel inhibitor is an activity inhibitor. For example, some inhibitorsof activity are small molecule inhibitors or peptide inhibitors. In yetanother embodiment the activity inhibitor is SNX-482. In anotherembodiment of the invention the R-type voltage-dependent calcium channelinhibitor is an expression inhibitor. For example, an antisenseoligonucleotide or siRNA molecule. In one embodiment of the inventionthe R-type voltage-dependent calcium channel inhibitor is administeredorally. Other embodiments of the invention include administration of theR-type voltage-dependent calcium channel inhibitor intravenously, byintrathecal route, by direct bronchial application, by a suppository,and during surgery.

In some embodiments the subject does not have symptoms of cerebralvasospasm. In other embodiments the subject has symptoms of cerebralvasospasm.

Optionally the R-type voltage dependent calcium channel inhibitor isadministered by infusion into cerebrospinal fluid. In some embodimentsthe R-type voltage dependent calcium channel inhibitor is an antisenseoligonucleotide.

In another aspect, the invention is a method for treating cerebralvasospasm, by administering to a subject in need thereof an effectiveamount for treating cerebral vasospasm of a L-type voltage-dependentcalcium channel inhibitor, wherein the L-type voltage dependent calciumchannel inhibitor is an antisense oligonucleotide of a L-type VDCCsmooth muscle splice variant. Optionally the L-type VDCC smooth musclesplice variant is CaV1.2 Exon 9 region.

Another aspect of the invention is a composition of an R-typevoltage-dependent calcium channel inhibitor and an anti-cerebralvasospasm drug formulated with a pharmaceutically-acceptable carrier. Inone embodiment of the invention, the R-type voltage-dependent calciumchannel inhibitor is an activity inhibitor. In another embodiment theactivity inhibitor is SNX-482. In still another embodiment of theinvention, the R-type voltage-dependent calcium channel inhibitor is anexpression inhibitor, for example, an antisense oligonucleotide or siRNAmolecule. In still another embodiment of the invention, the compositionis formulated for oral administration. In still another embodiment thecomposition is formulated for intravenous administration. In anotherembodiment of the invention the anti-cerebral vasospasm drug is anL-type voltage-dependent calcium channel inhibitor. Some examples ofL-type voltage-dependent calcium channel inhibitors are diltiazem, adihydropyridine such as nisoldipine, nicardipine or nifedipine, or aphenylalkalamine such as verapamil.

Another aspect of the invention is a container housing an R-typevoltage-dependent calcium channel inhibitor and instructions foradministering the R-type voltage-dependent calcium channel inhibitor toa subject having a neurological defect such as a subarachnoid hemorrhageor cerebral vasospasm.

Another aspect of the invention is an R-type voltage-dependent calciumchannel inhibitor and a pharmaceutically-acceptable carrier formulatedas a suppository.

Each of the limitations of the invention can encompass variousembodiments of the invention. It is, therefore, anticipated that each ofthe limitations of the invention involving any one element orcombinations of elements can be included in each aspect of theinvention. This invention is not limited in its application to thedetails of construction and the arrangement of components set forth inthe following description or illustrated in the drawings. The inventionis capable of other embodiments and of being practiced or of beingcarried out in various ways. Also, the phraseology and terminology usedherein is for the purpose of description and should not be regarded aslimiting. The use of “including,” “comprising,” or “having,”“containing”, “involving”, and variations thereof herein, is meant toencompass the items listed thereafter and equivalents thereof as well asadditional items.

BRIEF DESCRIPTION OF DRAWINGS

This application includes examples which refer to figures or otherdrawings. It is to be understood that the referenced figures areillustrative only and are not essential to the enablement of the claimedinvention.

FIG. 1 shows graphs depicting the diameter of cerebral arteries isolatedfrom control and SAH rabbits. FIGS. 1A and 1B are graphs showing theeffect of L-type voltage-gated calcium channel (VDCC) antagonists(inhibitors) on artery diameter. The y-axis is diameter in microns, andthe x-axis is time in minutes. FIG. 1C is a graph showing a summary ofpressure-induced constriction of cerebral arteries from control and SAHrabbits. The y-axis shows % constriction after pressurization. The graybars represent SAH rabbits and the black bars represent control rabbits.The x-axis shows measurements with and without L-type VDCC antagonist.Constriction is expressed as a percent decrease of the fully dilateddiameter. *p<0.05.

FIG. 2 shows graphs measuring voltage-dependent Ca²⁺ channel (VDCC)currents in native cerebral artery myocytes isolated from control (▪)and SAH (●) animals. FIGS. 2A and 2B show patch clamp electrophysiology.Conventional whole-cell patch clamp electrophysiology was used tomeasure inward currents elicited by 800 ms depolarizing voltage stepsfrom a holding potential of −80 mV with 10 mmol/L Ba²⁺ as the chargecarrier. Cell capacitance was 13.6 pF (control) and 19.7 pF (SAH). They-axis represents current in picoamps (pA) and the x-axis represent timein milliseconds. FIG. 2C is a graph showing the summary ofcurrent-voltage relationship of membrane currents in cells isolated fromcontrol (n=13) and SAH (n=11) myocytes. *p<0.05 **p<0.1. The y-axisrepresents current density in (pA/pf) and the x-axis represents membranepotential in milliamps. FIG. 2D is a graph showing tail currentsexpressed as a ratio of the maximum current for each cell (I/Imax). Tailcurrents were obtained by stepping cells to membrane potential between−70 mV and +40 mV for 20 ms, then measuring inward current at −80 mV.The interval between voltage steps was 20 s. The voltage forhalf-maximal (V_(0.5, act)) activation was obtained from Boltzmann fitof tail currents. V_(0.5,act) for control (0.8±0.7 mV, n=4) and SAH(−2.3±0.6 mV, n=7) were not significantly different, p>0.05.

FIG. 3 is a series of graphs depicting inactivation of VDCC currents incerebral artery myocytes isolated from control (▪) and SAH (●) animals.FIG. 3A shows steady state inactivation of VDCC currents from controland SAH myocytes were obtained using a double-step voltage protocol (seeinset of FIG. 3A) where every 10 seconds, cells are stepped from −80 mVto a membrane potential between −70 and +20 mV for 1 s, before membranecurrent is determined at +20 mV. The voltage for half-maximal(V_(0.5,inact)) inactivation for control (1.4±1.6 mV, n=6) and SAH(−13.8±1.2 mV, n=10) cells were determined from Boltzmann fit of data.The y-axis is the ratio of maximum current for each cell (I/Imax). FIG.3B is a summary of fast inactivation time constants from control (n=10)and SAH (n=10) myocytes. Fast inactivation time constants (τ₁) wereobtained by double exponential fit of current decay(I=A₁e^(−x/τ1)+A₂e^(−x/τ2)+C) during a 800 ms voltage step from −80 mVto +20 mV. FIG. 3C is a summary of slow inactivation time constants (τ₂)from control (n=10) and SAH (n=10) myocytes. For figures C and D they-axis is time in milliseconds and the x-axis is membrane potential inmillivolts. FIG. 3D shows the contribution of fast time constant tocurrent decay (A₁/A₁+A₂+C). Fitting parameters at +20 mV were: A₁=−52.5pA (control) and −83.0 pA (SAH), A₂=−15.5 pA (control) and −59.1 pA(SAH), C=−27.8 pA (control) and −44.1 pA (SAH). *p<0.05, **p<0.01. They-axis represents the time constant and the x-axis is membrane potentialin millivolts.

FIG. 4 is a series of graphs showing pharmacology of VDCC currents fromcontrol and SAH myocytes. FIG. 4A shows current recordings duringvoltage steps from −80 mV to +20 mV in the presence and absence ofdiltiazem (500 μmol/L). FIG. 4B shows concentration response curves ofcurrent inhibition by diltiazem in control (n=6-15 cells) and SAH(n=4-20 cells) myocytes. The y-axis is I/Imax and the x-axis isconcentration of diltiazem in micromoles. FIG. 4C shows the summary ofcurrent-voltage relationship of membrane currents in cells isolated fromcontrol (▪) and SAH (●) myocytes in the presence of 1000 μmol/Ldiltiazem. Dashed lines represent the current-voltage of control (blackdashed line) and SAH (gray dashed line) in the absence of diltiazem(from FIG. 2C). FIG. 4D shows the summary of the effects of ω-conotoxinGVIA (1 μmol/L, n=4) and co-agatoxin IVA (100 nmol/L, n=4) on VDCCcurrents from SAH myocytes. *p<0.05, **p<0.01. The y-axis is current inmilliamps and the x-axis is presence or absence of drug.

FIG. 5 is a series of graphs showing the effects of SNX-482 on VDCCcurrents and arterial diameter. FIG. 5A shows current recordings duringvoltage steps from −80 mV to +20 mV in the presence (gray line) andabsence (black line) of SNX-482 (200 nmol/L) obtained from cerebralartery myocytes of control (upper) and SAH (lower) animals. FIG. 5Bshows averaged peak current from voltage steps from −80 to +20 mVobtained at 20 s intervals of control (▪) and SAH (●) animals. Solid barrepresents the addition of SNX-482 to the extracellular solution. They-axis is current in picoamps. FIG. 5C shows diameter recordingsobtained from isolated cerebral arteries pressurized to 100 mmHg.Diltiazem (50 μmol/L) in nominally Ca²⁺-free physiological salinesolution (PSS) (0 Ca²⁺ PSS) was used to obtain maximal dilation for eachartery. Control animals are represented by the gray line and SAH animalsare represented by the black line. FIG. 5D shows the summary of effectsof SNX-482 on isolated cerebral arteries obtained from control and SAHanimals. **p<0.01. The y-axis is percent dilation.

FIG. 6 shows images of western blots measuring R-type VDCC Ca_(v) 2.3expression in cerebral arteries following SAH. FIG. 6A shows RT-PCRperformed using primers specific for Ca_(v) 2.3. The expected 1.1 kbproduct (white arrow) was detected using 200 ng of total RNA extractedfrom cerebral arteries from SAH, but not in control animals. Ca_(v) 2.3was also detected in RNA isolated from brain. PCR reactions wereperformed with (+) and without (−) reverse transcriptase (RT). FIG. 6Bshows RT-PCR performed on 50, 100 and 200 ng of RNA extracted fromintact cerebral arteries of control (left) and SAH (right) animals.Using primers specific for the L-type VDCC (Ca_(v) 1.2) the expectedproduct (white arrow) was detected in cerebral arteries from both SAHand control animals. PCR reactions were performed with (+) and without(−) reverse transcriptase (RT) on 200 ng samples.

FIG. 7 is a series of images showing immunofluorescent labeling ofCa_(v) 2.3 in cerebral arteries following SAH. FIGS. 7A and 7B showstaining, in blue, of a cerebral artery from a SAH (FIG. 7A) and acontrol (FIG. 7B) animal using an anti-Ca_(v) 2.3 primary antibody and aCy5 anti-rabbit secondary antibody. The cyanine nuclear dye, YOYO®-1 wasused to identify cell nuclei (in green). FIG. 7C is an image of anartery from a SAH animal when the anti-CaV 2.3 antibody was preadsorbedwith the control antigen peptide. FIG. 7D is an image of an artery froman SAH animal when the anti-Ca_(v) 2.3 antibody was omitted from thestaining procedure. Images were obtained using the same laser intensityand the scale bar in panel A is applicable to all panels.

FIG. 8 shows the normalized constriction profiles of the culturedarteries upon treatment with diltiazem at different time points. Allsamples were constricted by increasing the extracellular concentrationof K⁺ to 60 mM, prior to addition of diltiazem. FIG. 8A shows theprofile of the control sample directly upon harvest (day 0; square) andat day 1 (circle). The day 1 oxyhemoglobin treated sample is depicted bytriangles. FIG. 8B and FIG. 8C show the treatment regimens at 3 and 5days respectively, with the untreated samples depicted by circles andthe treated samples depicted by triangles. Experimental values are theaverage of four to seven experiment. Error bars represent the standarderror of the mean.

FIG. 9 shows the percentage of residual constriction of the arteriesthat have been cultured for 5 days under different treatment regimens.The left hand side of the panel shows control treatment, while the barson the right hand side depict oxyhemoglobin treated samples. Sampleswere exposed to 60 mM K⁺ to induce constriction, and were subsequentlytreated with 1 mM diltiazem (1^(st) bar) or with 1 mM diltiazem and 220nM SNX-482 (2^(nd) bar) to reverse constriction. Experimental values arethe average of four to five experiments. Error bars show the standarderror of the mean.

FIG. 10 shows the percentage of residual constriction of the arteriesthat have been cultured for 5 days under different treatment regimens.The left hand side of the panel shows control treatment, while the barson the right hand side depict oxyhemoglobin treated samples. Sampleswere exposed to 60 mM K⁺ (1^(st) bar), 60 mM K⁺ and 220 nM SNX-482(2^(nd) bar), 60 mM K⁺ and 1 mM diltiazem (3^(rd) bar) and a zero mMextracellular Ca2+ control (4^(th) bar). Experimental values are theaverage of three to four experiments. Error bars show the standard errorof the mean.

FIG. 11 shows two images of the results of PCR reactions to identifymRNA of CaV2.3 in cultured arteries. The results of the PCR reaction areshown on agarose gels. FIG. 11A shows representative results of RT-PCRreactions on control samples and samples treated with oxyhemoglobin.Samples without reverse transcriptase treatment (−RT) are included as anegative control. The band at 435 bp shows the existence of CaV2.3 mRNA.FIG. 11B shows representative results of nested PCR reactions on controlsamples and samples treated with oxyhemoglobin. Negative control samples(−RT) are also included. The band at 161 bp shows the existence ofCaV2.3 mRNA.

DETAILED DESCRIPTION

Cerebral artery vasospasm often follows aneurismal or traumaticsubarachnoid hemorrhage (SAH). Vasospasm is characterized by sustainedand delayed cerebral artery constriction and disrupts autoregulation andreduces optimal perfusion to brain tissue, leading to ischemia.Classically, cerebral artery vasospasm has been diagnosed usingangiography. Large diameter arteries have been implicated incontributing to decreased blood flow resulting from SAH. However, smalldiameter arteries, below the resolution limits of standard angiography,may also be affected by subarachnoid blood. Small diameter (100-200 μmdiameter) cerebral arteries from a rabbit model of SAH are significantlymore constricted at physiological intravascular pressures compared tosimilar arteries from healthy animals. This enhanced pressure-inducedconstriction of small diameter arteries may contribute to decreasedcerebral blood flow following SAH.

The invention is based in part on the discovery that such small diameterarteries have R-type voltage dependent calcium channels that areinvolved in regulating calcium flow and play an important role indecreased cerebral blood flow observed following SAH. To a great extent,the concentration of intracellular free calcium ions ([Ca²⁺]_(i))determines the contractile state of vascular smooth muscle, and thus,cerebral artery diameter which is a key component in the regulation ofglobal and local cerebral blood flow. Thus, it has been discovered thatSAH leads to enhanced Ca²⁺ entry in myocytes of small diameter cerebralarteries through the emergence of R-type voltage-dependent Ca²⁺ channels(VDCCs) encoded by the gene Ca_(v) 2.3.

As shown in the Examples section, in vitro diameter measurements andpatch clamp electrophysiology demonstrate that L-type VDCC antagonistsabolish cerebral artery constriction and block VDCC currents in cerebralartery myocytes from healthy animals. However, five days following theintracisternal injection of blood into rabbits to mimic SAH, cerebralartery constriction and VDCC currents were enhanced and partiallyresistant to L-type VDCC antagonists. Further, an antagonist of R-typeCa²⁺ channels, reduced constriction and membrane currents in cerebralarteries from SAH animals, but was without effect on cerebral arteriesof healthy animals. Consistent with the biophysical and functional data,cerebral arteries from healthy animals express only L-type VDCCs (Ca_(v)1.2), whereas following SAH, cerebral arteries were found to expressboth Ca_(v) 1.2 and Ca_(v) 2.3. R-type VDCCs may contribute to enhancedcerebral artery constriction following SAH. These R-type VDCCs thusrepresent an important therapeutic target in the treatment ofneurological deficits following SAH. More detail on these experiments isprovided in the examples section below.

Thus, the invention in one aspect relates to a method of treatingneurological deficits following SAH, such as cerebral vasospasm byadministering to a subject in need thereof an effective amount of anR-type VDCC inhibitor. An R-type voltage-dependent calcium channelinhibitor as used herein as a calcium entry blocking drug whose mainpharmacological effect is to prevent or slow the entry of calcium intocells via R-type voltage-gated calcium channels. Ca_(v)2.3 is theprincipal pore-forming unit of R-type voltage-dependent calcium channelsidentified herein as being expressed in neurons.

The methods of the invention are useful for treating a subject in needthereof. A subject in need thereof is a subject having or at risk ofhaving cerebral vasospasm. In its broadest sense, the terms “treatment”or “to treat” refer to both therapeutic and prophylactic treatments. Ifthe subject in need of treatment is experiencing a condition (i.e., hasor is having a particular condition), then “treating the condition”refers to ameliorating, reducing or eliminating one or more symptomsassociated with the disorder. If the subject in need of treatment is onewho is at risk of having a condition, then treating the subject refersto reducing the risk of the subject having the condition.

A subject having a cerebral vasospasm is one who has symptoms of or hasbeen diagnosed with cerebral vasospasm. A subject at risk of cerebralvasospasm is one who has one or more predisposing factors to thedevelopment of cerebral vasospams. An example of a predisposing factoris existence of a subarachnoid hemorrhage. A subject who has experienceda recent subarachnoid hemorrhage is at significantly higher risk ofdeveloping cerebral vasospasm than a subject who has not had a recentsubarachnoid hemorrhage. In some embodiments the subject is free ofdisorders otherwise calling for treatment with R-Type calcium channelinhibitors. In one embodiment such a disorder is a convulsion.

As used herein, a subject includes humans, non human primates, dogs,cats, sheep, goats, cows, pigs, horses and rodents. In preferredembodiments, the subject is human.

The invention provides methods and compositions to treat conditionswhich would benefit from, and which thus can be treated by, aninhibition of vasoconstriction, such as subarachnoid hemorrhage andpreferably cerebral vasospasm.

Agents useful for increasing arterial blood flow, inhibitingvasoconstriction or inducing vasodilation are agents which inhibitvoltage-dependent calcium channels such as R-type voltage-dependentcalcium channels (R-type VDCC) or L-type VDCC. These inhibitors embracecompounds which are R-type VDCC antagonists. Such inhibitors arereferred to as activity inhibitors or R-Type VDCC activity inhibitors.As used herein, an activity inhibitor is an agent which interferes withor prevents the activity of an R-type VDCC. An activity inhibitor mayinterfere with the ability of the R-type VDCC to bind an agonist. Anactivity inhibitor may be an agent which competes with a naturallyoccurring activator of R-type VDCC for interaction with the activationbinding site on the R-type VDCC. Alternatively, the activity inhibitormay bind to the R-type VDCC at a site distinct from the activationbinding site, but in doing so, it may, for example, cause aconformational change in the R-type VDCC which is transduced to theactivation binding site, thereby precluding binding of the naturalactivator. Alternatively, an activity inhibitor may interfere with acomponent upstream or downstream of the R-type VDCC but which interfereswith the activity of the R-type VDCC. This latter type of activityinhibitor is referred to as a functional antagonist.

An example of an R-type VDCC inhibitor which is an activity inhibitor isSNX-482. “SNX-482” is a peptide inhibitor of R-type voltage-gatedcalcium channels. SNX-482 can be isolated from the venom of the Africantarantula, Hysterocrates gigas. The peptide acts at presynaptic sitesand selectively inhibits the activity of R-type (α₁E) Ca²⁺ channel withhigh affinity and in a voltage-dependent manner. Structurally, SNX-482has a similar size and cysteine disulfide bond arrangement with twoother spider toxins, hanatoxin (which can inhibit voltage-gatedpotassium channels) and gramotoxin SIA (an inhibitor of voltage gatedcalcium channels isolated from the venom of Chilean tarantulaGrammostola spatulata or Phrixotrichus spatulata), that selectivelyblock calcium channels by altering their gating. Conserved residuesnecessary for inhibitory function include cysteine residues necessaryfor forming disulfide bridges that confer the tertiary structure of thepeptide. An example of the sequence for SNX-482 isH-Gly-Val-Asp-Lys-Ala-Gly-Cys-Arg-Tyr-Met-Phe-Gly-Gly-Cys-Ser-Val-Asn-Asp-Asp-Cys-Cys-Pro-Arg-Leu-Gly-Cys-His-Ser-Leu-Phe-Ser-Tyr-Cys-Ala-Trp-Asp-Leu-Thr-Phe-Ser-Asp-OH(SEQ ID NO:5).

One of skill in the art will recognize that conservative amino acidsubstitutions may be made without affecting structure and function ofSNX-482. As used herein, a “conservative amino acid substitution” or“conservative substitution” refers to an amino acid substitution inwhich the substituted amino acid residue is of similar charge as thereplaced residue and is of similar or smaller size than the replacedresidue. Conservative substitutions of amino acids include substitutionsmade amongst amino acids within the following groups: (a) the smallnon-polar amino acids, A, M, I, L, and V; (b) the small polar aminoacids, G, S, T and C; (c) the amido amino acids, Q and N; (d) thearomatic amino acids, F, Y and W; (e) the basic amino acids, K, R and H;and (f) the acidic amino acids, E and D. Substitutions which are chargeneutral and which replace a residue with a smaller residue may also beconsidered “conservative substitutions” even if the residues are indifferent groups (e.g., replacement of phenylalanine with the smallerisoleucine). The term “conservative amino acid substitution” also refersto the use of amino acid analogs or variants. A conservative amino acidsubstitution in the SNX-482 sequence would not include replacement ofall cysteine residues.

Other agents which are useful according to the methods of the inventionin the treatment of conditions described herein include agents whichinterfere with R-type VDCC expression at either the mRNA or proteinlevel. Such inhibitors are referred to as expression inhibitors orR-type VDCC expression inhibitors. Examples of expression inhibitorsinclude antisense oligonucleotides and therapeutic RNA.

Thus, the invention embraces antisense oligonucleotides that selectivelybind to a nucleic acid molecules encoding an R-type VDCC to decreaseexpression and activity of this protein and subunits thereof. Antisenseoligonucleotides can be designed to interfere with expression of theR-type VDCC based on the known nucleotides sequence of the R-type VDCC.For instance, the following oligonucleotides are useful as antisenseoligonucleotide inhibitors of the rabbit R-type VDCC: (SEQ ID NO:14)5′-CCACCTGTGCTGTCCCTGCCAC-3′ 22 mer (7056-7035) (SEQ ID NO:15)5′-ACTCGGGCCAGCCAGCTCCCTCCAC-3′ 25 mer (7695-7671) (SEQ ID NO:16)5′-GCCAGACCCTCCCTTCCC-3′ 18 mer (7634-7617) (SEQ ID NO:17)5′-ACTCAGCAGGTCGCCCACAGCGCCAC-3′ 26 mer (7354-7329) (SEQ ID NO:18)5′-GCCATCTGCATGCTGCTCT-3′ 19 mer (3655-3637) (SEQ ID NO:19)5′-GCCAGCCATGGCGGCTCCC-3′ 19 mer (3225-3207)

The invention also embraces antisense oligonucleotides that selectivelybind to a nucleic acid molecules encoding an L-type VDCC to decreaseexpression and activity of this protein and subunits thereof,particularly the splice variants that are found in smooth musclearteries. Antisense oligonucleotides can be designed to interfere withexpression of the L-type VDCC based on the known nucleotides sequence ofthe L-type VDCC. For instance, the following oligonucleotides are usefulas antisense oligonucleotide inhibitors of the rabbit L-type VDCC smoothmuscle splice variants (CaV1.2 Exon 9 region):5′-AAGCCCGCTGGAGTGCCTCT-3′ (SEQ ID NO:20). An antisense strand sequencetargeting a common region of Rabbit CaV 1.2 is5′-CTCTTCCAGCTGCTGCTTCTCCC-3′ (SEQ ID NO:21).

Similar oligonucleotides for the human R- and L-type VDCC may easily beidentified. For instance oligonucleotides can be developed against thehuman genes using the criteria described below, such as optimal lengthand stabilization. Additional criteria include selection of positivemotifs such as: CCAC, TCCC, ACTC, GCCA, CTCT and exclusion of negativemotifs such as: GGGG, ACTG, AAA, TAA.

As used herein, the term “antisense oligonucleotide” or “antisense”describes an oligonucleotide that is an oligoribonucleotide,oligodeoxyribonucleotide, modified oligoribonucleotide, or modifiedoligodeoxyribonucleotide which hybridizes under physiological conditionsto DNA comprising a particular gene or to an mRNA transcript of thatgene and, thereby, inhibits the transcription of that gene and/or thetranslation of that mRNA. The antisense oligonucleotide molecules aredesigned so as to interfere with transcription or translation of atarget gene upon hybridization with the target gene or transcript.Antisense oligonucleotides that selectively bind to a nucleic acidmolecule encoding an R-type VDCC are particularly preferred. Thoseskilled in the art will recognize that the exact length of the antisenseoligonucleotide and its degree of complementarity with its target willdepend upon the specific target selected, including the sequence of thetarget and the particular bases which comprise that sequence.

It is preferred that the antisense oligonucleotide be constructed andarranged so as to bind selectively with the target under physiologicalconditions, i.e., to hybridize substantially more to the target sequencethan to any other sequence in the target cell under physiologicalconditions. Based upon the nucleotide sequences of nucleic acidmolecules encoding R-type VDCC, (e.g., GenBank Accession Nos. NM009782—R type alpha 1E subunit) or upon allelic or homologous genomicand/or cDNA sequences, one of skill in the art can easily choose andsynthesize any of a number of appropriate antisense oligonucleotidemolecules for use in accordance with the present invention. In order tobe sufficiently selective and potent for inhibition, such antisenseoligonucleotides should comprise at least about 10 and, more preferably,at least about 15 consecutive bases which are complementary to thetarget, although in certain cases modified oligonucleotides as short as7 bases in length have been used successfully as antisenseoligonucleotides. See Wagner et al., Nat. Med 1(11):1116-1118, 1995.Most preferably, the antisense oligonucleotides comprise a complementarysequence of 20-30 bases. Although oligonucleotides may be chosen whichare antisense to any region of the gene or mRNA transcripts, inpreferred embodiments the antisense oligonucleotides correspond toN-terminal or 5′ upstream sites such as translation initiation,transcription initiation or promoter sites. In addition, 3′-untranslatedregions may be targeted by antisense oligonucleotides. Targeting to mRNAsplicing sites has also been used in the art but may be less preferredif alternative mRNA splicing occurs. In addition, the antisense istargeted, preferably, to sites in which mRNA secondary structure is notexpected (see, e.g., Sainio et al., Cell Mol. Neurobiol. 14(5):439-457,1994) and at which proteins are not expected to bind.

In one set of embodiments, the antisense oligonucleotides of theinvention may be composed of “natural” deoxyribonucleotides,ribonucleotides, or any combination thereof. That is, the 5′ end of onenative nucleotide and the 3′ end of another native nucleotide may becovalently linked, as in natural systems, via a phosphodiesterinternucleoside linkage. These oligonucleotides may be prepared by artrecognized methods which may be carried out manually or by an automatedsynthesizer. They also may be produced recombinantly by vectors.

In preferred embodiments, however, the antisense oligonucleotides of theinvention also may include “modified” oligonucleotides. That is, theoligonucleotides may be modified in a number of ways which do notprevent them from hybridizing to their target but which enhance theirstability or targeting or which otherwise enhance their therapeuticeffectiveness.

The term “modified oligonucleotide” as used herein describes anoligonucleotide in which (1) at least two of its nucleotides arecovalently linked via a synthetic internucleoside linkage (i.e., alinkage other than a phosphodiester linkage between the 5′ end of onenucleotide and the 3′ end of another nucleotide) and/or (2) a chemicalgroup not normally associated with nucleic acid molecules has beencovalently attached to the oligonucleotide. Preferred syntheticinternucleoside linkages are phosphorothioates, alkylphosphonates,phosphorodithioates, phosphate esters, alkylphosphonothioates,phosphoramidates, carbamates, carbonates, phosphate triesters,acetamidates, carboxymethyl esters and peptides.

The term “modified oligonucleotide” also encompasses oligonucleotideswith a covalently modified base and/or sugar. For example, modifiedoligonucleotides include oligonucleotides having backbone sugars whichare covalently attached to low molecular weight organic groups otherthan a hydroxyl group at the 3′ position and other than a phosphategroup at the 5′ position. Thus modified oligonucleotides may include a2′-O-alkylated ribose group. In addition, modified oligonucleotides mayinclude sugars such as arabinose instead of ribose.

The present invention, thus, contemplates pharmaceutical preparationscontaining modified antisense oligonucleotide molecules that arecomplementary to and hybridizable with, under physiological conditions,nucleic acid molecules encoding R-type VDCC, together withpharmaceutically acceptable carriers. Antisense oligonucleotides may beadministered as part of a pharmaceutical composition. In this latterembodiment, it may be preferable that a slow intravenous administrationbe used. Such a pharmaceutical composition may include the antisenseoligonucleotides in combination with any standard physiologically and/orpharmaceutically acceptable carriers which are known in the art. Thecompositions should be sterile and contain a therapeutically effectiveamount of the antisense oligonucleotides in a unit of weight or volumesuitable for administration to a subject.

The methods of the invention also encompass use of isolated short RNAthat directs the sequence-specific degradation of R-type VDCC mRNAthrough a process known as RNA interference (RNAi). The process is knownto occur in a wide variety of organisms, including embryos of mammalsand other vertebrates. It has been demonstrated that dsRNA is processedto RNA segments 21-23 nucleotides (nt) in length, and furthermore, thatthey mediate RNA interference in the absence of longer dsRNA. Thus,these 21-23 nt fragments are sequence-specific mediators of RNAdegradation and are referred to herein as siRNA or RNAi. Methods of theinvention encompass the use of these fragments (or recombinantlyproduced or chemically synthesized oligonucleotides of the same orsimilar nature) to enable the targeting of R-type VDCC mRNAs fordegradation in mammalian cells useful in the therapeutic applicationsdiscussed herein.

The methods for design of the RNA's that mediate RNAi and the methodsfor transfection of the RNAs into cells and animals is well known in theart and are readily commercially available (Verma N. K. et al, J. Clin.Pharm. Ther., 28(5):395-404(2004), Mello C. C. et al. Nature,431(7006)338-42 (2004), Dykxhoom D. M. et al., Nat. Rev. Mol. Cell Biol.4(6):457-67 (2003) Proligo (Hamburg, Germany), Dharmacon Research(Lafayette, Colo., USA), Pierce Chemical (part of Perbio Science,Rockford, Ill., USA), Glen Research (Sterling, Va., USA), ChemGenes(Ashland, Mass., USA), and Cruachem (Glasgow, UK)). The RNAs arepreferably chemically synthesized using appropriately protectedribonucleoside phosphoramidites and a conventional DNA/RNA synthesizer.Most conveniently, siRNAs are obtained from commercial RNA oligosynthesis suppliers listed herein. In general, RNAs are not toodifficult to synthesize and are readily provided in a quality suitablefor RNAi. A typical 0.2 μmol-scale RNA synthesis provides about 1milligram of RNA, which is sufficient for 1000 transfection experimentsusing a 24-well tissue culture plate format.

The R-type VDCC cDNA specific siRNA is designed preferably by selectinga sequence that is not within 50-100 bp of the start codon and thetermination codon, avoids intron regions, avoids stretches of 4 or morebases such as AAAA, CCCC, avoids regions with GC content <30% or >60%,avoids repeats and low complex sequence, and it avoids single nucleotidepolymorphism sites. The R-type VDCC siRNA may be designed by a searchfor a 23-nt sequence motif AA(N₁₉). If no suitable sequence is found,then a 23-nt sequence motif NA(N₂₁) may be used with conversion of the3′ end of the sense siRNA to TT. Alternatively, the R-type VDCC siRNAcan be designed by a search for NAR(N₁₇)YNN. The target sequence mayhave a GC content of around 50%. The siRNA targeted sequence may befurther evaluated using a BLAST homology search to avoid off targeteffects on other genes or sequences. Negative controls are designed byscrambling targeted siRNA sequences. The control RNA preferably has thesame length and nucleotide composition as the siRNA but has at least 4-5bases mismatched to the siRNA. The RNA molecules of the presentinvention can comprise a 3′ hydroxyl group. The RNA molecules can besingle-stranded or double stranded; such molecules can be blunt ended orcomprise overhanging ends (e.g., 5′, 3′) from about 1 to about 6nucleotides in length (e.g., pyrimidine nucleotides, purinenucleotides). In order to further enhance the stability of the RNA ofthe present invention, the 3′ overhangs can be stabilized againstdegradation. The RNA can be stabilized by including purine nucleotides,such as adenosine or guanosine nucleotides. Alternatively, substitutionof pyrimidine nucleotides by modified analogues, e.g., substitution ofuridine 2 nucleotide 3′ overhangs by 2′-deoxythymidine is tolerated anddoes not affect the efficiency of RNAi. The absence of a 2′ hydroxylsignificantly enhances the nuclease resistance of the overhang in tissueculture medium.

The RNA molecules used in the methods of the present invention can beobtained using a number of techniques known to those of skill in theart. For example, the RNA can be chemically synthesized or recombinantlyproduced using methods known in the art. Such methods are described inU.S. Published Patent Application Nos. US2002-0086356A1 andUS2003-0206884A1 which are hereby incorporated by reference in theirentirety.

The methods described herein are used to identify or obtain RNAmolecules that are useful as sequence-specific mediators of R-type VDCCmRNA degradation and, thus, for inhibiting R-type VDCC receptoractivity. Expression of the R-type VDCC receptor can be inhibited inhumans in order to prevent the disease or condition from occurring,limit the extent to which it occurs or reverse it.

The RNA molecules may also be isolated using a number of techniquesknown to those of skill in the art. For example, gel electrophoresis canbe used to separate RNAs from the combination, gel slices comprising theRNA sequences removed and RNAs eluted from the gel slices.Alternatively, non-denaturing methods, such as non-denaturing columnchromatography, can be used to isolate the RNA produced. In addition,chromatography (e.g., size exclusion chromatography), glycerol gradientcentrifugation, affinity purification with antibody can be used toisolate RNAs.

Any RNA can be used in the methods of the present invention, providedthat it has sufficient homology to the R-type VDCC receptor gene tomediate RNAi. The RNA for use in the present invention can correspond tothe entire R-type VDCC receptor gene or a portion thereof. There is noupper limit on the length of the RNA that can be used. For example, theRNA can range from about 21 base pairs (bp) of the gene to the fulllength of the gene or more. In one embodiment, the RNA used in themethods of the present invention is about 1000 bp in length. In anotherembodiment, the RNA is about 500 bp in length. In yet anotherembodiment, the RNA is about 22 bp in length. In certain embodiments thepreferred length of the RNA of the invention is 21 to 23 nucleotides.

The inhibitors described herein are isolated molecules. An isolatedmolecule is a molecule that is substantially pure and is free of othersubstances with which it is ordinarily found in nature or in vivosystems to an extent practical and appropriate for its intended use. Inparticular, the molecular species are sufficiently pure and aresufficiently free from other biological constituents of host cells so asto be useful in, for example, producing pharmaceutical preparations orsequencing if the molecular species is a nucleic acid, peptide, orpolysaccharide. Because an isolated molecular species of the inventionmay be admixed with a pharmaceutically-acceptable carrier in apharmaceutical preparation, the molecular species may comprise only asmall percentage by weight of the preparation. The molecular species isnonetheless substantially pure in that it has been substantiallyseparated from the substances with which it may be associated in livingsystems.

“Subarachnoid hemorrhage” (SAH) is a condition in which blood collectsbeneath the arachnoid mater, a membrane that covers the brain. Thisarea, called the subarachnoid space, normally contains cerebrospinalfluid. The accumulation of blood in the subarachnoid space can lead tostroke, seizures, and other complications. Additionally, subarachnoidhemorrhages may cause permanent brain damage and a number of harmfulbiochemical events in the brain. In some instances, subarachnoidhemorrhages include non-traumatic types of hemorrhages, usually causedby rupture of a berry aneurysm or arteriovenous malformation (AVM).Other causes include bleeding from a vascular anomaly and extension intothe subarachnoid space from a primary intracerebral hemorrhage. Symptomsof subarachnoid hemorrhage include sudden and severe headache, nauseaand/or vomiting, symptoms of meningeal irritation (eg, neck stiffness,low back pain, bilateral leg pain) photophobia and visual changes,and/or loss of consciousness.

Subarachnoid hemorrhage is often secondary to a head injury or a bloodvessel defect known as an aneurysm. In some instances, subarachnoidhemorrhage can induce a cerebral vasospasm that may in turn lead to anischemic stroke. A common manifestation of a subarachnoid hemorrhage isthe presence of blood in the CSF.

Subjects having a subarachnoid hemorrhage can be identified by a numberof symptoms. For example, a subject having a subarachnoid hemorrhagewill present with blood in the subarachnoid, usually in a large amount.Subjects having a subarachnoid hemorrhage can also be identified by anintracranial pressure that approximates mean arterial pressure, by afall in cerebral perfusion pressure or by the sudden transient loss ofconsciousness (sometimes preceded by a painful headache). In about halfof cases, subjects present with a severe headache which may beassociated with physical exertion. Other symptoms associated withsubarachnoid hemorrhage include nausea, vomiting, memory loss,hemiparesis and aphasia. Subjects having a subarachnoid hemorrhage canalso be identified by the presence of creatine kinase-BB isoenzymeactivity in their CSF. This enzyme is enriched in the brain but isnormally not present in the CSF. Thus, its presence in the CSF isindicative of “leak” from the brain into the subarachnoid. Assay ofcreatine-kinase BB isoenzyme activity in the CSF is described by Coplinet al. (Coplin, et al, Arch Neurol, 1999, 56(11):1348-1352)Additionally, a spinal tap or lumbar puncture can be used to demonstrateif there is blood present in the CSF, a strong indication of asubarachnoid hemorrhage. A cranial CT scan or an MRI can also be used toidentify blood in the subarachnoid region. Angiography can also be usedto determine not only whether a hemorrhage has occurred but also thelocation of the hemorrhage.

Subarachnoid hemorrhage commonly results from rupture of an intracranialsaccular aneurysm or from malformation of the arteriovenous system in,and leading to, the brain. Accordingly, a subject at risk of having asubarachnoid hemorrhage includes subjects having a saccular aneurysm aswell as subjects having a malformation of the arteriovenous system. Itis estimated that 5% of the population have such aneurysms yet only 1 in10,000 people actually have a subarachnoid hemorrhage. The top of thebasilar artery and the junction of the basilar artery with the superiorcerebellar or the anterior inferior cerebellar artery are common sitesof saccular aneurysms. Subjects having a subarachnoid hemorrhage may beidentified by an eye examination, whereby slowed eye movement mayindicate brain damage. A subject with a developing saccular aneurysm canbe identified through routine medical imaging techniques, such as CT andMRI. A developing aneurysm forms a mushroom-like shape (sometimesreferred to as “a dome with a neck” shape).

A vasospasm is a sudden decrease in the internal diameter of a bloodvessel that results from contraction of smooth muscle within the wall ofthe vessel. Vasospasms result in decreased blood flow, but increasedsystem vascular resistance. It is generally believed that vasospasm iscaused by local injury to vessels, such as that which results fromatherosclerosis and other structural injury including traumatic headinjury. Cerebral vasospasm is a naturally occurring vasoconstrictionwhich can also be triggered by the presence of blood in the CSF, acommon occurrence after rupture of an aneurysm or following traumatichead injury. Cerebral vasospasm can ultimately lead to brain celldamage, in the form of cerebral ischemia and infarction, due tointerrupted blood supply.

Cerebral vasospasm is characterized by a sudden decrease in the internaldiameter of a blood vessel that results from contraction of smoothmuscle within the wall of the vessel. This causes a decrease in cerebralblood flow, but an increase in vascular resistance. As used herein,cerebral vasospasm refers to the delayed occurrence of narrowing oflarge capacity arteries at the base of the brain after subarachnoidhemorrhage, often associated with diminished perfusion in the territorydistal to the affected vessel. Cerebral vasospasm can occur any timeafter rupture of an aneurysm but most commonly peaks at seven daysfollowing the hemorrhage and often resolves within 14 days when theblood has been absorbed by the body.

A subject having a vasospasm is a subject who presents with diagnosticmarkers and symptoms associated with vasospasm. Diagnostic markersinclude the presence of blood in the CSF and/or a recent history of asubarachnoid hemorrhage. Vasospasm associated symptoms include paralysison one side of the body, inability to vocalize the words or tounderstand spoken or written words, and inability to perform tasksrequiring spatial analysis. Such symptoms may develop over a few days,or they may fluctuate in their appearance, or they may present abruptly.

MR angiography and CT angiography can be used to diagnose cerebralvasospasm. Angiography is a technique in which a contrast agent isintroduced into the blood stream in order to view blood flow and/orarteries. A contrast agent is required because blood flow and/orarteries are sometimes only weakly apparent in a regular MR or CT scan.Appropriate contrast agents will vary depending upon the imagingtechnique used. For example, gadolinium is a common contrast agent usedin MR scans. Other MR appropriate contrast agents are known in the art.Transcranial Doppler ultrasound can also be used to diagnose and monitorthe progression of a vasospasm. As mentioned earlier, the presence ofblood in the cerebrospinal fluid can be detected using CT scans.However, in some instances where the amount of blood is so small as tonot be detected by CT, a lumbar puncture is warranted.

A subject at risk of a vasospasm includes a subject who has detectableblood in the cerebrospinal fluid, or one who has a detectable aneurysmas detected by a CT scan, yet has not begun to experience the symptomsassociated with having a vasospasm. A subject at risk of a vasospasm mayalso one who has experienced a traumatic head injury. Traumatic headinjury usually results from a physical force to the head region, in theform of a fall or a forceful contact with a solid object. Subjects atrisk of a vasospasm may also include those who have recently (e.g., inthe last two weeks or months) experienced a subarachnoid hemorrhage (asdescribed above).

In one aspect of the invention, an R-type VDCC inhibitor is administeredto the subject having or at risk of having a vasospasm in an effectiveamount to treat a vasospasm. An effective amount to treat a vasospasmmay be that amount necessary to ameliorate, reduce or eliminatealtogether one or more symptoms relating to a vasospasm, preferablyincluding brain damage that results from vasospasm such as an infarct.Brain damage can be measured anatomically using medical imagingtechniques to measure infarct sizes. Alternatively or in conjunction,brain damage may be measured functionally in terms of cognitive orsensory skills of the subject.

Inhibitors can be combined with other therapeutic agents, such as ananti-cerebral vasospasm drug. The inhibitor and other therapeutic agentmay be administered simultaneously or sequentially. When the othertherapeutic agents are administered simultaneously they can beadministered in the same or separate formulations, but are administeredat the same time. The other therapeutic agents are administeredsequentially with one another and with inhibitor, when theadministration of the other therapeutic agents and the inhibitor istemporally separated. The separation in time between the administrationof these compounds may be a matter of minutes or it may be longer.

Subjects at risk of vasospasm are currently administered a variety ofpreventative medications including L-type voltage-dependent calciumchannel (L-type VDCC) inhibitors (e.g., nimodipine), phenylephrine,dopamine, as well as a combination of mannitol and hyperventilation.Some forms of prophylactic treatments aim to increase the cerebralperfusion pressure. In accordance with the present invention, any ofthese prophylactic therapies may be co-administered to a subject at riskof having a vasospasm along with the agents of the invention. Thus,other therapeutic agents include but are not limited to anti-cerebralvasospasm drug such as L-type VDCC and a phenylalkalamine such asverapamil, etc.

An L-type voltage-dependent calcium channel inhibitor as used herein asa calcium entry blocking drug whose main pharmacological effect is toprevent or slow the entry of calcium into cells via L-type voltage-gatedcalcium channels. α_(1C) (Ca_(v)1.2) and α_(1D) (Ca_(v)1.3) are the twoprincipal pore-forming units of L-type voltage-dependent calciumchannels expressed in neurons. α_(1C) (Ca_(v)1.2) is also present incerebral artery myocytes. Examples of L-type calcium channel inhibitorsinclude but are not limited to: dihydropyridine L-type blockers such asnisoldipine, nicardipine and nifedipine, AHF (such as4aR,9aS)-(+)-4a-Amino-1,2,3,4,4a,9a-hexahydro-4aH-fluorene, HCl),isradipine (such as4-(4-Benzofurazanyl)-1,-4-dihydro-2,6-dimethyl-3,5-pyridinedicarboxylicacid methyl 1-methhylethyl ester), Calciseptin/calciseptine (such asisolated from (Dendroaspis polylepis. ploylepis,H-Arg-Ile-Cys-Tyr-Ile-His-Lys-Ala-Ser-Leu-Pro-Arg-Ala-Thr-Lys-Thr-Cys-Val-Glu-Asn-Thr-Cys-Tyr-Lys-Met-Phe-Ile-Arg-Thr-Gln-Arg-Glu-Tyr-Ile-Ser-Glu-Arg-Gly-Cys-Gly-Cys-Pro-Thr-Ala-Met-Trp-Pro-Tyr-Gln-Thr-Glu-Cys-Cys-Lys-Gly-Asp-Arg-Cys-Asn-Lys-OH(SEQ ID NO:6), Calcicludine (such as isolated from Dendroaspisangusticeps (eastern green mamba)),(H-Trp-Gln-Pro-Pro-Trp-Tyr-Cys-Lys-Glu-Pro-Val-Arg-Ile-Gly-Ser-Cys-Lys-Lys-Gln-Phe-Ser-Ser-Phe-Tyr-Phe-Lys-Trp-Thr-Ala-Lys-Lys-Cys-Leu-Pro-Phe-Leu-Phe-Ser-Gly-Cys-Gly-Gly-Asn-Ala-Asn-Arg-Phe-Gln-Thr-Ile-Gly-Glu-Cys-Arg-Lys-Lys-Cys-Leu-Gly-Lys-OH,SEQ ID NO:7), Cilnidipine (such as also FRP-8653, a dihydropyridine-typeinhibitor), Dilantizem (such as(2S,3S)-(+)-cis-3-Acetoxy-5-(2-dimethylaminoethyl)-2,3-dihydro-2-(4-methoxyphenyl)-1,5-benzothiazepin-4(5H)-onehydrochloride), diltiazem (such as benzothiazepin-4(5H)-one,3-(acetyloxy)-5-[2-(dimethylamino)ethyl]-2,3-dihydro-2-(4-methoxyphenyl)-,(+)-cis-,monohydrochloride), Felodipine (such as4-(2,3-Dichlorophenyl)-1,4-dihydro-2,6-dimethyl-3,5-pyridinecarboxylicacid ethyl methyl ester), FS-2 (such as an isolate from Dendroaspispolylepis polylepis venom), FTX-3.3 (such as an isolate from Agelenopsisaperta), Neomycin sulfate (such as C₂₃H₄₆N₆O₁₃. 3H₂SO₄), Nicardipine(such as1,4-Dihydro-2,6-dimethyl-4-(3-nitrophenyl)methyl-2-[methyl(phenylmethyl)amino]-3,5-pyridinedicarboxylicacid ethyl ester hydrochloride, also YC-93, Nifedipine (such as1,4-Dihydro-2,6-dimethyl-4-(2-nitrophenyl)-3,5-pyridinedicarboxylic aciddimethyl ester), Nimodipine (such as4-Dihydro-2,6-dimethyl-4-(3-nitrophenyl)-3,5-pyridinedicarboxylic acid2-methoxyethyl 1-methylethyl ester) or (Isopropyl 2-methoxyethyl1,4-dihydro-2,6-dimethyl-4-(m-nitrophenyl)-3,5-pyridinedicarboxylate),Nitrendipine (such as1,4-Dihydro-2,6-dimethyl-4-(3-nitrophenyl)-3,5-pyridinedicarboxylic acidethyl methyl ester), S-Petasin (such as (3S,4aR,5R,6R)-[2,3,4,4a,5,6,7,8-Octahydro-3-(2-propenyl)-4a,5-dimethyl-2-oxo-6-naphthyl]Z-3′-methylthio-1′-propenoate),Phloretin (such as 2′,4′,6′-Trihydroxy-3-(4-hydroxyphenyl)propiophenone, also3-(4-Hydroxyphenyl)-1-(2,4,6-trihydroxyphenyl)-1-propanone, alsob-(4-Hydroxyphenyl)-2,4,6-trihydroxypropiophenone), Protopine (such asC₂₀H₁₉NO₅.HCl), SKF-96365 (such as1-[b-[3-(4-Methoxyphenyl)propoxy]-4-methoxyphenethyl]-1H-imidazole,HCl), Tetrandine (such as 6,6′,7,12-Tetramethoxy-2,2′-dimethylberbaman),(±)-Methoxyverapamil or (+)-Verapamil (such as5-[N-(3,4-Dimethoxyphenylethyl)methylamino]-2-(3,4-dimethoxyphenyl)-2-isopropylvaleronitrilehydrochloride), and (R)-(+)-Bay K8644 (such asR-(+)-1,4-Dihydro-2,6-dimethyl-5-nitro-4-[2-(trifluoromethyl)phenyl]-3-pyridinecarboxylicacid methyl ester). The foregoing examples may be specific to L-typevoltage-gated calcium channels or may inhibit a broader range ofvoltage-gated calcium channels, e.g. N, P/Q, R, and T-type.

The compositions are delivered in effective amounts. The term effectiveamount refers to the amount necessary or sufficient to realize a desiredbiologic effect. Combined with the teachings provided herein, bychoosing among the various active compounds and weighing factors such aspotency, relative bioavailability, patient body weight, severity ofadverse side-effects and preferred mode of administration, an effectiveprophylactic or therapeutic treatment regimen can be planned which doesnot cause substantial toxicity and yet is effective to treat theparticular subject. The effective amount for any particular applicationcan vary depending on such factors as the disease or condition beingtreated, the particular inhibitor being administered, the size of thesubject, or the severity of the disease or condition. One of ordinaryskill in the art can empirically determine the effective amount of aparticular inhibitor and/or other therapeutic agent withoutnecessitating undue experimentation. It is preferred generally that amaximum dose be used, that is, the highest safe dose according to somemedical judgment. Multiple doses per day may be contemplated to achieveappropriate systemic levels of compounds. Appropriate system levels canbe determined by, for example, measurement of the patient's peak orsustained plasma level of the drug. “Dose” and “dosage” are usedinterchangeably herein.

Generally, daily oral doses of active compounds will be from about 0.01milligrams/kg per day to 1000 milligrams/kg per day. It is expected thatoral doses in the range of 0.5 to 50 milligrams/kg, in one or severaladministrations per day, will yield the desired results. Dosage may beadjusted appropriately to achieve desired drug levels, local orsystemic, depending upon the mode of administration. For example, it isexpected that intravenous administration would be from an order toseveral orders of magnitude lower dose per day. In the event that theresponse in a subject is insufficient at such doses, even higher doses(or effective higher doses by a different, more localized deliveryroute) may be employed to the extent that patient tolerance permits.Multiple doses per day are contemplated to achieve appropriate systemiclevels of compounds.

For any compound described herein the therapeutically effective amountcan be initially determined from preliminary in vitro studies and/oranimal models. A therapeutically effective dose can also be determinedfrom human data for inhibitors which have been tested in humans and forcompounds which are known to exhibit similar pharmacological activities,such as other related active agents. Higher doses may be required forparenteral administration. The applied dose can be adjusted based on therelative bioavailability and potency of the administered compound.Adjusting the dose to achieve maximal efficacy based on the methodsdescribed above and other methods as are well-known in the art is wellwithin the capabilities of the ordinarily skilled artisan.

The formulations of the invention are administered in pharmaceuticallyacceptable solutions, which may routinely contain pharmaceuticallyacceptable concentrations of salt, buffering agents, preservatives,compatible carriers, adjuvants, and optionally other therapeuticingredients.

For use in therapy, an effective amount of the inhibitor can beadministered to a subject by any mode that delivers the inhibitor to thedesired surface. Administering the pharmaceutical composition of thepresent invention may be accomplished by any means known to the skilledartisan. Preferred routes of administration include but are not limitedto oral, intrathecal, intra-arterial, direct bronchial application,direct infusion into cerebrospinal fluid (CSF), parenteral (e.g.intravenous), intramuscular, intranasal, sublingual, intratracheal,inhalation, ocular, vaginal, and rectal, e.g., using a suppository. Theinhibitors and other therapeutics may also be delivered to a subjectduring surgery to treat the underlying condition such as subarachnoidhemorrhage or during intra-arterial procedures.

In some embodiments direct infusion into CSF is preferred. Delivery ofthe agents of the invention to the CSF allows the compounds immediateaccess to cerebral artery myocytes, where they can act on thevoltage-dependent calcium channels. This route also limits the exposureof the agent to other body tissues, thus limiting side effects.Administration of antisense oligonucleotides by this route is preferredin some embodiments.

For oral administration, the compounds (i.e., inhibitors, and othertherapeutic agents) can be formulated readily by combining the activecompound(s) with pharmaceutically acceptable carriers well known in theart. Such carriers enable the compounds of the invention to beformulated as tablets, pills, dragees, capsules, liquids, gels, syrups,slurries, suspensions and the like, for oral ingestion by a subject tobe treated. Pharmaceutical preparations for oral use can be obtained assolid excipient, optionally grinding a resulting mixture, and processingthe mixture of granules, after adding suitable auxiliaries, if desired,to obtain tablets or dragee cores. Suitable excipients are, inparticular, fillers such as sugars, including lactose, sucrose,mannitol, or sorbitol; cellulose preparations such as, for example,maize starch, wheat starch, rice starch, potato starch, gelatin, gumtragacanth, methyl cellulose, hydroxypropylmethyl-cellulose, sodiumcarboxymethylcellulose, and/or polyvinylpyrrolidone (PVP). If desired,disintegrating agents may be added, such as the cross-linked polyvinylpyrrolidone, agar, or alginic acid or a salt thereof such as sodiumalginate. Optionally the oral formulations may also be formulated insaline or buffers, i.e. EDTA for neutralizing internal acid conditionsor may be administered without any carriers.

Also specifically contemplated are oral dosage forms of the abovecomponent or components. The component or components may be chemicallymodified so that oral delivery of the derivative is efficacious.Generally, the chemical modification contemplated is the attachment ofat least one moiety to the component molecule itself, where said moietypermits (a) inhibition of proteolysis; and (b) uptake into the bloodstream from the stomach or intestine. Also desired is the increase inoverall stability of the component or components and increase incirculation time in the body. Examples of such moieties include:polyethylene glycol, copolymers of ethylene glycol and propylene glycol,carboxymethyl cellulose, dextran, polyvinyl alcohol, polyvinylpyrrolidone and polyproline. Abuchowski and Davis, 1981, “SolublePolymer-Enzyme Adducts” In: Enzymes as Drugs, Hocenberg and Roberts,eds., Wiley-Interscience, New York, N.Y., pp. 367-383; Newmark, et al.,1982, J. Appl. Biochem. 4:185-189. Other polymers that could be used arepoly-1,3-dioxolane and poly-1,3,6-tioxocane. Preferred forpharmaceutical usage, as indicated above, are polyethylene glycolmoieties.

For the component (or derivative) the location of release may be thestomach, the small intestine (the duodenum, the jejunum, or the ileum),or the large intestine. One skilled in the art has availableformulations which will not dissolve in the stomach, yet will releasethe material in the duodenum or elsewhere in the intestine. Preferably,the release will avoid the deleterious effects of the stomachenvironment, either by protection of the inhibitor (or derivative) or byrelease of the biologically active material beyond the stomachenvironment, such as in the intestine.

To ensure full gastric resistance a coating impermeable to at least pH5.0 is essential. Examples of the more common inert ingredients that areused as enteric coatings are cellulose acetate trimellitate (CAT),hydroxypropylmethylcellulose phthalate (HPMCP), HPMCP 50, HPMCP 55,polyvinyl acetate phthalate (PVAP), Eudragit L30D, Aquateric, celluloseacetate phthalate (CAP), Eudragit L, Eudragit S, and Shellac. Thesecoatings may be used as mixed films.

A coating or mixture of coatings can also be used on tablets, which arenot intended for protection against the stomach. This can include sugarcoatings, or coatings which make the tablet easier to swallow. Capsulesmay consist of a hard shell (such as gelatin) for delivery of drytherapeutic i.e. powder; for liquid forms, a soft gelatin shell may beused. The shell material of cachets could be thick starch or otheredible paper. For pills, lozenges, molded tablets or tablet triturates,moist massing techniques can be used.

The therapeutic can be included in the formulation as finemulti-particulates in the form of granules or pellets of particle sizeabout 1 mm. The formulation of the material for capsule administrationcould also be as a powder, lightly compressed plugs or even as tablets.The therapeutic could be prepared by compression.

Colorants and flavoring agents may all be included. For example, theinhibitor (or derivative) may be formulated (such as by liposome ormicrosphere encapsulation) and then further contained within an edibleproduct, such as a refrigerated beverage containing colorants andflavoring agents.

One may dilute or increase the volume of the therapeutic with an inertmaterial. These diluents could include carbohydrates, especiallymannitol, a-lactose, anhydrous lactose, cellulose, sucrose, modifieddextrans and starch. Certain inorganic salts may be also be used asfillers including calcium triphosphate, magnesium carbonate and sodiumchloride. Some commercially available diluents are Fast-Flo, Emdex,STA-Rx 1500, Emcompress and Avicell.

Disintegrants may be included in the formulation of the therapeutic intoa solid dosage form. Materials used as disintegrates include but are notlimited to starch, including the commercial disintegrant based onstarch, Explotab. Sodium starch glycolate, Amberlite, sodiumcarboxymethylcellulose, ultramylopectin, sodium alginate, gelatin,orange peel, acid carboxymethyl cellulose, natural sponge and bentonitemay all be used. Another form of the disintegrants are the insolublecationic exchange resins. Powdered gums may be used as disintegrants andas binders and these can include powdered gums such as agar, Karaya ortragacanth. Alginic acid and its sodium salt are also useful asdisintegrants.

Binders may be used to hold the therapeutic agent together to form ahard tablet and include materials from natural products such as acacia,tragacanth, starch and gelatin. Others include methyl cellulose (MC),ethyl cellulose (EC) and carboxymethyl cellulose (CMC). Polyvinylpyrrolidone (PVP) and hydroxypropylmethyl cellulose (HPMC) could both beused in alcoholic solutions to granulate the therapeutic.

An anti-frictional agent may be included in the formulation of thetherapeutic to prevent sticking during the formulation process.Lubricants may be used as a layer between the therapeutic and the diewall, and these can include but are not limited to; stearic acidincluding its magnesium and calcium salts, polytetrafluoroethylene(PTFE), liquid paraffin, vegetable oils and waxes. Soluble lubricantsmay also be used such as sodium lauryl sulfate, magnesium laurylsulfate, polyethylene glycol of various molecular weights, Carbowax 4000and 6000.

Glidants that might improve the flow properties of the drug duringformulation and to aid rearrangement during compression might be added.The glidants may include starch, talc, pyrogenic silica and hydratedsilicoaluminate.

To aid dissolution of the therapeutic into the aqueous environment asurfactant might be added as a wetting agent. Surfactants may includeanionic detergents such as sodium lauryl sulfate, dioctyl sodiumsulfosuccinate and dioctyl sodium sulfonate. Cationic detergents mightbe used and could include benzalkonium chloride or benzethomiumchloride. The list of potential non-ionic detergents that could beincluded in the formulation as surfactants are lauromacrogol 400,polyoxyl 40 stearate, polyoxyethylene hydrogenated castor oil 10, 50 and60, glycerol monostearate, polysorbate 40, 60, 65 and 80, sucrose fattyacid ester, methyl cellulose and carboxymethyl cellulose. Thesesurfactants could be present in the formulation of the inhibitor orderivative either alone or as a mixture in different ratios.

Pharmaceutical preparations which can be used orally include push-fitcapsules made of gelatin, as well as soft, sealed capsules made ofgelatin and a plasticizer, such as glycerol or sorbitol. The push-fitcapsules can contain the active ingredients in admixture with fillersuch as lactose, binders such as starches, and/or lubricants such astalc or magnesium stearate and, optionally, stabilizers. In softcapsules, the active compounds may be dissolved or suspended in suitableliquids, such as fatty oils, liquid paraffin, or liquid polyethyleneglycols. In addition, stabilizers may be added. Microspheres formulatedfor oral administration may also be used. Such microspheres have beenwell defined in the art. All formulations for oral administration shouldbe in dosages suitable for such administration.

For buccal administration, the compositions may take the form of tabletsor lozenges formulated in conventional manner.

For administration by inhalation, the compounds for use according to thepresent invention may be conveniently delivered in the form of anaerosol spray presentation from pressurized packs or a nebulizer, withthe use of a suitable propellant, e.g., dichlorodifluoromethane,trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide orother suitable gas. In the case of a pressurized aerosol the dosage unitmay be determined by providing a valve to deliver a metered amount.Capsules and cartridges of e.g. gelatin for use in an inhaler orinsufflator may be formulated containing a powder mix of the compoundand a suitable powder base such as lactose or starch.

Also contemplated herein is pulmonary delivery of the inhibitors (orderivatives thereof). The inhibitor (or derivative) is delivered to thelungs of a mammal while inhaling and traverses across the lungepithelial lining to the blood stream. Other reports of inhaledmolecules include Adjei et al., 1990, Pharmaceutical Research,7:565-569; Adjei et al., 1990, International Journal of Pharmaceutics,63:135-144 (leuprolide acetate); Braquet et al., 1989, Journal ofCardiovascular Pharmacology, 13(suppl. 5):143-₁₄₆ (endothelin-1);Hubbard et al., 1989, Annals of Internal Medicine, Vol. III, pp. 206-212(a1-antitrypsin); Smith et al., 1989, J. Clin. Invest. 84:1145-1146(a-1-proteinase); Oswein et al., 1990, “Aerosolization of Proteins”,Proceedings of Symposium on Respiratory Drug Delivery II, Keystone,Colo., March, (recombinant human growth hormone); Debs et al., 1988, J.Immunol. 140:3482-3488 (interferon-g and tumor necrosis factor alpha)and Platz et al., U.S. Pat. No. 5,284,656 (granulocyte colonystimulating factor). A method and composition for pulmonary delivery ofdrugs for systemic effect is described in U.S. Pat. No. 5,451,569,issued Sep. 19, 1995 to Wong et al.

Contemplated for use in the practice of this invention are a wide rangeof mechanical devices designed for pulmonary delivery of therapeuticproducts, including but not limited to nebulizers, metered doseinhalers, and powder inhalers, all of which are familiar to thoseskilled in the art.

Some specific examples of commercially available devices suitable forthe practice of this invention are the Ultravent nebulizer, manufacturedby Mallinckrodt, Inc., St. Louis, Mo.; the Acorn II nebulizer,manufactured by Marquest Medical Products, Englewood, Colo.; theVentolin metered dose inhaler, manufactured by Glaxo Inc., ResearchTriangle Park, N.C.; and the Spinhaler powder inhaler, manufactured byFisons Corp., Bedford, Mass.

All such devices require the use of formulations suitable for thedispensing of inhibitor (or derivative). Typically, each formulation isspecific to the type of device employed and may involve the use of anappropriate propellant material, in addition to the usual diluents,adjuvants and/or carriers useful in therapy. Also, the use of liposomes,microcapsules or microspheres, inclusion complexes, or other types ofcarriers is contemplated. Chemically modified inhibitor may also beprepared in different formulations depending on the type of chemicalmodification or the type of device employed.

Formulations suitable for use with a nebulizer, either jet orultrasonic, will typically comprise inhibitor (or derivative) dissolvedin water at a concentration of about 0.1 to 25 mg of biologically activeinhibitor per mL of solution. The formulation may also include a bufferand a simple sugar (e.g., for inhibitor stabilization and regulation ofosmotic pressure). The nebulizer formulation may also contain asurfactant, to reduce or prevent surface induced aggregation of theinhibitor caused by atomization of the solution in forming the aerosol.

Formulations for use with a metered-dose inhaler device will generallycomprise a finely divided powder containing the inhibitor (orderivative) suspended in a propellant with the aid of a surfactant. Thepropellant may be any conventional material employed for this purpose,such as a chlorofluorocarbon, a hydrochlorofluorocarbon, ahydrofluorocarbon, or a hydrocarbon, including trichlorofluoromethane,dichlorodifluoromethane, dichlorotetrafluoroethanol, and1,1,1,2-tetrafluoroethane, or combinations thereof. Suitable surfactantsinclude sorbitan trioleate and soya lecithin. Oleic acid may also beuseful as a surfactant.

Formulations for dispensing from a powder inhaler device will comprise afinely divided dry powder containing inhibitor (or derivative) and mayalso include a bulking agent, such as lactose, sorbitol, sucrose, ormannitol in amounts which facilitate dispersal of the powder from thedevice, e.g., 50 to 90% by weight of the formulation. The inhibitor (orderivative) should most advantageously be prepared in particulate formwith an average particle size of less than 10 mm (or microns), mostpreferably 0.5 to 5 mm, for most effective delivery to the distal lung.

Nasal delivery of a pharmaceutical composition of the present inventionis also contemplated. Nasal delivery allows the passage of apharmaceutical composition of the present invention to the blood streamdirectly after administering the therapeutic product to the nose,without the necessity for deposition of the product in the lung.Formulations for nasal delivery include those with dextran orcyclodextran.

For nasal administration, a useful device is a small, hard bottle towhich a metered dose sprayer is attached. In one embodiment, the metereddose is delivered by drawing the pharmaceutical composition of thepresent invention solution into a chamber of defined volume, whichchamber has an aperture dimensioned to aerosolize and aerosolformulation by forming a spray when a liquid in the chamber iscompressed. The chamber is compressed to administer the pharmaceuticalcomposition of the present invention. In a specific embodiment, thechamber is a piston arrangement. Such devices are commerciallyavailable.

Alternatively, a plastic squeeze bottle with an aperture or openingdimensioned to aerosolize an aerosol formulation by forming a spray whensqueezed is used. The opening is usually found in the top of the bottle,and the top is generally tapered to partially fit in the nasal passagesfor efficient administration of the aerosol formulation. Preferably, thenasal inhaler will provide a metered amount of the aerosol formulation,for administration of a measured dose of the drug.

The compounds, when it is desirable to deliver them systemically, may beformulated for parenteral administration by injection, e.g., by bolusinjection or continuous infusion. Formulations for injection may bepresented in unit dosage form, e.g., in ampoules or in multi-dosecontainers, with an added preservative. The compositions may take suchforms as suspensions, solutions or emulsions in oily or aqueousvehicles, and may contain formulatory agents such as suspending,stabilizing and/or dispersing agents.

Pharmaceutical formulations for parenteral administration includeaqueous solutions of the active compounds in water-soluble form.Additionally, suspensions of the active compounds may be prepared asappropriate oily injection suspensions. Suitable lipophilic solvents orvehicles include fatty oils such as sesame oil, or synthetic fatty acidesters, such as ethyl oleate or triglycerides, or liposomes. Aqueousinjection suspensions may contain substances which increase theviscosity of the suspension, such as sodium carboxymethyl cellulose,sorbitol, or dextran. Optionally, the suspension may also containsuitable stabilizers or agents which increase the solubility of thecompounds to allow for the preparation of highly concentrated solutions.

Alternatively, the active compounds may be in powder form forconstitution with a suitable vehicle, e.g., sterile pyrogen-free water,before use.

The compounds may also be formulated in rectal or vaginal compositionssuch as suppositories or retention enemas, e.g., containing conventionalsuppository bases such as cocoa butter or other glycerides.Suppositories are a solid dosage form of medication that can bedelivered internally to a patient, human or animal by insertion of thesolid dosage form directly to the an area of the body. Known types ofsuppositories include rectal, vaginal and urethral suppositories.Commonly used bases, which are commercially available for suppositoriesinclude PCCA Base MBK™ (Fatty Acid Base, PCCA), PCCA Base A™ (Polyglycol1450 MW, NF, PCCA), PCCA Base F™ (Synthetic Cocoa Butter, PCCA),Wecobee® M, R, S, W (Vegetable Oil, Hydrogenated, tepan Company,Northfield, Ill.), Witepsol® H12, H15, W35 (Vegetable Oil,Hydrogenated), Hydrokote® M (Vegetable Oil, Hydrogenated, AbitecCorporation, Columbus, Ohio), COA Base (Fatty Acid Base, SpectrumPharmacy Products, Tucson), Supposibase (PEG/Vegetable, SpectrumPharmacy Products, Tucson), Base A, B, D, Polyethylene Glycols, SpectrumPharmacy Products, Tucson), and Polybase (Polyethylene Glycol Blend,Gallipot, Inc., St. Paul, Minn.)

In addition to the formulations described previously, the compounds mayalso be formulated as a depot preparation. Such long acting formulationsmay be formulated with suitable polymeric or hydrophobic materials (forexample as an emulsion in an acceptable oil) or ion exchange resins, oras sparingly soluble derivatives, for example, as a sparingly solublesalt.

The pharmaceutical compositions also may comprise suitable solid or gelphase carriers or excipients. Examples of such carriers or excipientsinclude but are not limited to calcium carbonate, calcium phosphate,various sugars, starches, cellulose derivatives, gelatin, and polymerssuch as polyethylene glycols.

Suitable liquid or solid pharmaceutical preparation forms are, forexample, aqueous or saline solutions for inhalation, microencapsulated,encochleated, coated onto microscopic gold particles, contained inliposomes, nebulized, aerosols, pellets for implantation into the skin,or dried onto a sharp object to be scratched into the skin. Thepharmaceutical compositions also include granules, powders, tablets,coated tablets, (micro)capsules, suppositories, syrups, emulsions,suspensions, creams, drops or preparations with protracted release ofactive compounds, in whose preparation excipients and additives and/orauxiliaries such as disintegrants, binders, coating agents, swellingagents, lubricants, flavorings, sweeteners or solubilizers arecustomarily used as described above. The pharmaceutical compositions aresuitable for use in a variety of drug delivery systems. For a briefreview of methods for drug delivery, see Langer, Science 249:1527-1533,1990, which is incorporated herein by reference.

The inhibitors and optionally other therapeutics may be administered perse (neat) or in the form of a pharmaceutically acceptable salt. Whenused in medicine the salts should be pharmaceutically acceptable, butnon-pharmaceutically acceptable salts may conveniently be used toprepare pharmaceutically acceptable salts thereof. Such salts include,but are not limited to, those prepared from the following acids:hydrochloric, hydrobromic, sulphuric, nitric, phosphoric, maleic,acetic, salicylic, p-toluene sulphonic, tartaric, citric, methanesulphonic, formic, malonic, succinic, naphthalene-2-sulphonic, andbenzene sulphonic. Also, such salts can be prepared as alkaline metal oralkaline earth salts, such as sodium, potassium or calcium salts of thecarboxylic acid group.

Suitable buffering agents include: acetic acid and a salt (1-2% w/v);citric acid and a salt (1-3% w/v); boric acid and a salt (0.5-2.5% w/v);and phosphoric acid and a salt (0.8-2% w/v). Suitable preservativesinclude benzalkonium chloride (0.003-0.03% w/v); chlorobutanol (0.3-0.9%w/v); parabens (0.01-0.25% w/v) and thimerosal (0.004-0.02% w/v).

The pharmaceutical compositions of the invention contain an effectiveamount of an inhibitor and optionally therapeutic agents included in apharmaceutically-acceptable carrier. The termpharmaceutically-acceptable carrier means one or more compatible solidor liquid filler, diluents or encapsulating substances which aresuitable for administration to a human or other vertebrate animal. Theterm carrier denotes an organic or inorganic ingredient, natural orsynthetic, with which the active ingredient is combined to facilitatethe application. The components of the pharmaceutical compositions alsoare capable of being commingled with the compounds of the presentinvention, and with each other, in a manner such that there is nointeraction which would substantially impair the desired pharmaceuticalefficiency.

The therapeutic agent(s), including specifically but not limited to theinhibitor, may be provided in particles. Particles as used herein meansnano or microparticles (or in some instances larger) which can consistin whole or in part of the inhibitor or the other therapeutic agent(s)as described herein. The particles may contain the therapeutic agent(s)in a core surrounded by a coating, including, but not limited to, anenteric coating. The therapeutic agent(s) also may be dispersedthroughout the particles. The therapeutic agent(s) also may be adsorbedinto the particles. The particles may be of any order release kinetics,including zero order release, first order release, second order release,delayed release, sustained release, immediate release, and anycombination thereof, etc. The particle may include, in addition to thetherapeutic agent(s), any of those materials routinely used in the artof pharmacy and medicine, including, but not limited to, erodible,nonerodible, biodegradable, or nonbiodegradable material or combinationsthereof. The particles may be microcapsules which contain the inhibitorin a solution or in a semi-solid state. The particles may be ofvirtually any shape.

Both non-biodegradable and biodegradable polymeric materials can be usedin the manufacture of particles for delivering the therapeutic agent(s).Such polymers may be natural or synthetic polymers. The polymer isselected based on the period of time over which release is desired.Bioadhesive polymers of particular interest include bioerodiblehydrogels described by H. S. Sawhney, C. P. Pathak and J. A. Hubell inMacromolecules, (1993) 26:581-587, the teachings of which areincorporated herein. These include polyhyaluronic acids, casein,gelatin, glutin, polyanhydrides, polyacrylic acid, alginate, chitosan,poly(methyl methacrylates), poly(ethyl methacrylates),poly(butylmethacrylate), poly(isobutyl methacrylate),poly(hexylmethacrylate), poly(isodecyl methacrylate), poly(laurylmethacrylate), poly(phenyl methacrylate), poly(methyl acrylate),poly(isopropyl acrylate), poly(isobutyl acrylate), and poly(octadecylacrylate).

The therapeutic agent(s) may be contained in controlled release systems.The term “controlled release” is intended to refer to anydrug-containing formulation in which the manner and profile of drugrelease from the formulation are controlled. This refers to immediate aswell as non-immediate release formulations, with non-immediate releaseformulations including but not limited to sustained release and delayedrelease formulations. The term “sustained release” (also referred to as“extended release”) is used in its conventional sense to refer to a drugformulation that provides for gradual release of a drug over an extendedperiod of time, and that preferably, although not necessarily, resultsin substantially constant blood levels of a drug over an extended timeperiod. The term “delayed release” is used in its conventional sense torefer to a drug formulation in which there is a time delay betweenadministration of the formulation and the release of the drug therefrom. “Delayed release” may or may not involve gradual release of drugover an extended period of time, and thus may or may not be “sustainedrelease.”

Use of a long-term sustained release implant may be particularlysuitable for treatment of chronic conditions. “Long-term” release, asused herein, means that the implant is constructed and arranged todeliver therapeutic levels of the active ingredient for at least 7 days,and preferably 30-60 days. Long-term sustained release implants arewell-known to those of ordinary skill in the art and include some of therelease systems described above.

The invention also includes kits. The kit has a container housing anR-type-VDCC inhibitor and optionally additional containers with othertherapeutics such as anti-cerebral vasospasm drugs. The kit alsoincludes instructions for administering the component(s) to a subjectwho has or is at risk of having a cerebral vasospasm.

In some aspects of the invention, the kit can include a pharmaceuticalpreparation vial, a pharmaceutical preparation diluent vial, andinhibitor. The vial containing the diluent for the pharmaceuticalpreparation is optional. The diluent vial contains a diluent such asphysiological saline for diluting what could be a concentrated solutionor lyophilized powder of inhibitor. The instructions can includeinstructions for mixing a particular amount of the diluent with aparticular amount of the concentrated pharmaceutical preparation,whereby a final formulation for injection or infusion is prepared. Theinstructions may include instructions for use in a suppository or otherdevice useful according to the invention. The instructions can includeinstructions for treating a patient with an effective amount ofinhibitor. It also will be understood that the containers containing thepreparations, whether the container is a bottle, a vial with a septum,an ampoule with a septum, an infusion bag, and the like, can containindicia such as conventional markings which change color when thepreparation has been autoclaved or otherwise sterilized.

Exemplary R-type VDCC inhibitors are described above. Other activityinhibitors or antagonists may be identified by those of skill in the artfollowing the guidance described herein.

Libraries of compounds or other putative compounds can be screened toidentify other activity inhibitors. Putative compounds can besynthesized from peptides or other biomolecules including but notlimited to saccharides, fatty acids, sterols, isoprenoids, purines,pyrimidines, derivatives or structural analogs of the above, orcombinations thereof and the like. Phage display libraries and chemicalcombinatorial libraries can be used to develop and select syntheticcompounds which are capable of inhibiting R-type VDCC. Also envisionedin the invention is the use of compounds made from peptoids, randombio-oligomers (U.S. Pat. No. 5,650,489), benzodiazepines, diversomeressuch as dydantoins, benzodiazepines and dipeptides, nonpeptidalpeptidomimetics with a beta-D-glucose scaffolding, oligocarbamates orpeptidyl phosphonates.

Library technology can be used to identify small molecules, includingsmall peptides, which bind to a R-type VDCC ligand binding site, or aprotein interaction domain of an R-type VDCC. One advantage of usinglibraries for antagonist identification is the facile manipulation ofmillions of different putative candidates of small size in smallreaction volumes (i.e., in synthesis and screening reactions). Anotheradvantage of libraries is the ability to synthesize antagonists whichmight not otherwise be attainable using naturally occurring sources,particularly in the case of non-peptide moieties.

Many if not all of these compounds can be synthesized using recombinantor chemical libraries. A vast array of candidate compounds can begenerated from libraries of synthetic or natural compounds. Libraries ofnatural compounds in the form of bacterial, fungal, plant and animalextracts are available or can readily produced. Natural andsynthetically produced libraries and compounds can be readily modifiedthrough conventional chemical, physical, and biochemical means. Inaddition, compounds known to bind to and thereby act as antagonists ofcalcium channels may be subjected to directed or random chemicalmodifications such as acylation, alkylation, esterification,amidification, etc. to produce structural analogs which may functionsimilarly or perhaps with greater specificity.

Small molecule combinatorial libraries may also be generated. Acombinatorial library of small organic compounds is a collection ofclosely related analogs that differ from each other in one or morepoints of diversity and are synthesized by organic techniques usingmulti-step processes. As an example, analogs of SNX-482 can be generatedwhich function as R-type VDCC inhibitors or antagonists. Analogs ofthese compounds can be synthesized using combinatorial libraries.

Combinatorial libraries include a vast number of small organiccompounds. One type of combinatorial library is prepared by means ofparallel synthesis methods to produce a compound array. A “compoundarray” as used herein is a collection of compounds identifiable by theirspatial addresses in Cartesian coordinates and arranged such that eachcompound has a common molecular core and one or more variable structuraldiversity elements. The compounds in such a compound array are producedin parallel in separate reaction vessels, with each compound identifiedand tracked by its spatial address. Examples of parallel synthesismixtures and parallel synthesis methods are provided in PCT publishedpatent application W095/18972, published Jul. 13, 1995 and U.S. Pat. No.5,712,171 granted Jan. 27, 1998 and its corresponding PCT publishedpatent application W096/22529, which are hereby incorporated byreference.

The compounds generated using the recombinant and chemical librariesdescribed herein can be initially screened to identify putativecompounds by virtue of their ability to bind to R-type VDCC. Compoundssuch as library members can be screened for their ability to bind toR-type VDCC in vitro using standard binding assays well known to theordinary artisan and described below. For binding to an R-type VDCC, theR-type VDCC may be presented in a number of ways including but notlimited to cells expressing the R-type VDCC of interest, an isolatedextracellular domain of an R-type VDCC, a fragment thereof or a fusionprotein of the extracellular domain of an R-type VDCC and anotherprotein such as an immunoglobulin or a GST polypeptide or in a purified(e.g., a recombinantly produced form). For some high throughputscreening assays the use of purified forms of an R-type VDCC, itsextracellular domain or a fusion of its extracellular domain withanother protein may be preferable. Isolation of binding partners may beperformed in solution or in solid state according to well-known methods.

Standard binding assays are well known in the art, and a number of theseare suitable in the present invention including ELISA, competitionbinding assay, sandwich assays, radioreceptor assays using radioactivelylabeled ligands or substrates of R-type VDCC (with the binding of thenative, radioactively labeled, activator being competed with by theputative antagonist), electrophoretic mobility shift assays,immunoassays, cell-based assays such as two- or three-hybrid screens,etc. The nature of the assay is not essential provided it issufficiently sensitive to detect binding of a small number of librarymembers.

A variety of other reagents also can be included in the binding mixture.These include reagents such as salts, buffers, neutral proteins (e.g.,albumin), detergents, etc. which may be used to facilitate optimalmolecular interactions. Such a reagent may also reduce non-specific orbackground interactions of the reaction components. Other reagents thatimprove the efficiency of the assay may also be used. The mixture of theforegoing assay materials is incubated under conditions under which theR-type VDCC normally specifically binds one or more of its activators.The order of addition of components, incubation temperature, time ofincubation, and other parameters of the assay may be readily determined.Such experimentation merely involves optimization of the assayparameters, not the fundamental composition of the assay. Incubationtemperatures typically are between 4° C. and 40° C. Incubation timespreferably are minimized to facilitate rapid, high throughput screening,and typically are between 0.1 and 10 hours. After incubation, thepresence or absence of specific binding between the compounds isdetected by any convenient method available to the user.

Typically, a plurality of assay mixtures are run in parallel withdifferent agent concentrations to obtain a different response to thevarious concentrations. One of these concentrations serves as a negativecontrol, i.e., at zero concentration of agent or at a concentration ofagent below the limits of assay detection.

Once compounds have been identified which are capable of interactingwith R-type VDCC these compounds can be further screened for theirability to modulate vasoconstriction. An exemplary assay for measuringthe effect of a compound on vasoconstriction, the patch clamp technique,is described in the Examples. In that assay, vascular smooth musclecells are removed from SAH rabbits and bathed in a physiologicalsolution and then subjected to the patch clamp technique. The identicalarterial segments may be used to test the contractile response to acontrol substance and the test compound (e.g., compounds which areidentified as described above). Contractile responses can be measureddirectly using the methods described in the examples. The muscle cellsmay be exposed to increasing amounts of the test compound in order toarrive at a dose-response curve and an estimation of the appropriatedosage. Modulation of vasoconstriction can also be measured using anassay which records intraluminal pressure in perfused isolated vessels.

The present invention is further illustrated by the following Examples,which in no way should be construed as further limiting. The entirecontents of all of the references (including literature references,issued patents, published patent applications, and co-pending patentapplications) cited throughout this application are hereby expresslyincorporated by reference.

EXAMPLES

Methods

SAH Model. New Zealand white rabbits (males, 3.0-3.5 kg) were initiallyanesthetized by isoflurane (5%) using an induction chamber, thenintubated and maintained on isoflurane (2-3%) for the duration of thesurgical procedure. As described previously (Ishiguro M, et al Am JPhysiol Heart Circ Physiol. 2002;283:H2217-H2225), 3 ml of unheparinizedblood was injected into the cisternal magna. Buprenorphine (0.01 mg/kg)was given every 12 hours (for 36 hours, then as needed) as an analgesic.In the present study, cerebral arteries were obtained from control (nosurgery) and SAH (5 days post-surgery) animals. Rabbits were euthanizedby exsanguination under deep pentobarbital anesthesia (i.v.; 60 mg/kgbody weight). Posterior cerebral and cerebellar arteries (100-200 μmdiameter), which are consistently located within the clot region of SAHanimals, were dissected from the brain in cold (4° C.), oxygenated (20%O₂/5% CO₂/75% N₂) physiological saline solution (PSS) of the followingcomposition (in mmol/L): 119 NaCl, 4.7 KCl, 24 NaHCO₃, 1.2 KH₂PO₄, 1.6CaCl₂, 1.2 MgSO₄, 0.023 EDTA, 10 glucose. All protocols were conductedin accordance with the guidelines for the care and use of laboratoryanimals (NIH publication 85-23, 1985) and followed protocols approved bythe Institutional Animal Use and Care Committee of the University ofVermont, USA.

Diameter Measurements in Isolated Arteries. Cerebral artery segmentswere cannulated on glass pipettes mounted in a 5 ml myograph chamber(Living Systems Instruments, Burlington, Vt.) and superfused withaerated PSS (20% O₂/5% CO₂/75% N₂) at 37° C. and pH 7.4, as previouslydescribed (Ishiguro M, et al Am J Physiol Heart Circ Physiol.2002;283:H2217-H2225). Arterial diameter was measured with video edgedetection equipment and recorded using data acquisition software (DataqInstruments Inc., Akron, Ohio).

Organ culture of cerebral arteries. Cerebral arteries (100 to 200 μm indiameter) were isolated from the freshly harvested anterior andposterior circulation and maintained in cold MOPS solution. Once bloodwas gently flushed from the lumen, arteries were transferred into serumfree Dulbecco's modified Eagle's medium (DMEM)/F12 supplemented withpenicillin-streptomycin (1% vol/vol) and placed in an incubator at 37°C. with 5% CO₂ and 97% humidity. Arteries were cultured for 0-5 days inthe presence or absence of purified hemoglobin A_(O) (oxy form; 10μmol/L, Hemosol; Toronto, Canada). Culture medium was changed twicedaily to maintain oxyhemoglobin levels.

Measurements of VDCC currents. Vascular smooth muscle cells wereenzymatically isolated from cerebral arteries as previously described(Wellman G C et al. Stroke. 2002;33:802-808). The conventional wholecell configuration of the patch clamp technique was used to measurewhole cell VDCC currents in cerebral artery myocytes. The external(bath) solution contained (in mmol/L): 125 NaCl, 10 BaCl₂, 5 KCl, 10HEPES, 1 MgCl₂, 10 glucose, pH adjusted to 7.4 with NaOH. Patch pipettes(3-5 MΩ) were filled with an internal solution that contained (inmmol/L): 130 CsCl, 10 ethylene glycol-bis(β-aminoethylether)-N,N,N′,N′-tetraacetic acid, 10 HEPES, 1 MgCl₂, 2 ATP, 0.5 GTP, 5phosphocreatine, 10 glucose, pH adjusted to 7.2 with CsOH. K_(i) valuesfor diltiazem and nifedipine were determined from Hill plot ofconcentration-response curves of currents using the following equation:y=I_(max)/{1+([drug]/K_(i))^(n)}+r, where I_(max), [drug], n and rdenote the maximum effect, concentration of drug (diltiazem ornifedipine), Hill coefficient and drug resistant current, respectively.Experiments were performed at 24-26° C.

RNA isolation and RT-PCR. Total RNA was extracted and quantified fromcultured arteries at Day 5 or freshly harvested cerebral arteries andfirst strand cDNA was synthesized using Omniscript® RT kit (Qiagen,Valencia, Calif.). To perform RT-PCR, α₁ VDCC subunit specific primerswere generated from unique coding regions for Ca_(v) 2.3 and Ca_(v) 1.2.The following sets of primers were used: Ca_(v) 2.3 (GenBank Accessionno. X67855) sense nucleotides 5692-5709 (5′-CCC CAG GAA ATC ATC GCC-3′(SEQ ID NO:1)), and antisense nucleotides 6771-6750 (5′-GTC CTC AGT GCTACT CAG C-3′ (SEQ ID NO:2)); Ca_(v) 1.2 (GenBank Accession no. X55763)sense nucleotides 5380-5398 (5′-AAT GCC AAC AAC ACT GCC C-3′ (SEQ IDNO:3)), antisense nucleotides 6211-6193 (5′-CTT CGG AAA TCA AGA CCG C-3′(SEQ ID NO:4)). For the experiments on oxyhemoglobin exposed arteries adifferent primer set was used for CaV2.3 (GenBank Accession # X67855):sense nucleotides 6562-6580 (5′-GAG CAG CGA CAA CAC CTA C-3′ (SEQ IDNO:8)) and antisense nucleotides 6996-6978 (5′-GCT GGT GGA GAG AAG TTGC-3′ (SEQ ID NO:9)). cDNA was amplified under the following RT-PCRconditions: 94° C. 3 min for pre-incubation, 94° C. 1 min, 55-57° C. 1min, 72° C. 1.5 min for 35 cycles followed by an incubation at 72° C.for 10 min. Nested PCR was employed using another unique coding regionof CaV2.3 with the following sets of primers: sense nucleotides3586-3605 (5′-ACC CCT CGT CCT GTC CTC AC-3′ (SEQ ID NO:10)) andantisense nucleotides 3773-3754 (5′-TGC TCT CGG TGG TGA CCT TG-3′ (SEQID NO:11)) for the 1^(st) round PCR; sense nucleotides 3607-3625 (5′-CGAGGG TGT GGG GAA AGA G-3′ (SEQ ID NO: 12)) and antisense nucleotides3767-3748 (5′-CGG TGG TGA CCT TGT CTG TG-3′ (SEQ ID NO: 13) for the2^(nd) round PCR.

Immunofluorescence. Whole-mount arteries were fixed with 10% formalin atroom temperature for 1.5 hours then permeabilized and blocked with 0.1%Triton-X100/2% bovine serum albumin in PBS (pH 7.4). Arteries werestained using rabbit anti-Ca_(v) 2.3 (primary antibody obtained fromAlomone labs, Jerusalem, Israel) and Cy5 anti-rabbit as a secondaryantibody. Images were obtained using a Bio-Rad laser confocal microscope(excitation 650 nm and emission 670 for Cy5) (Bio-Rad Laboratories,Hercules, Calif.). The cyanine nuclear dye, YOYO®-1 (excitation 490 nmand emission 510 nm) was used to identify cell nuclei (Molecular Probes,Inc., Eugene, Oreg.).

Statistical Analysis. Data are presented as mean ±SEM. Statisticalsignificance was considered at the level of p<0.05 (*) or p<0.01 (**)using Student's t-test.

Example 1 Cerebral Artery Constriction Becomes Partially Resistant toL-Type VDCC Antagonists Following SAH

To examine the effects of subarachnoid blood on small diameter cerebralarteries, an established model of SAH was used, where blood (3 ml) wasinjected into the cisterna magna of anesthetized rabbits (Ishiguro M, etal Am J Physiol Heart Circ Physiol. 2002;283:H2217-H2225). Five daysfollowing this surgery, to obtain in vitro diameter measurements usingvideo microscopy, isolated 100-200 μm diameter cerebral arteries werecannulated and pressurized to 100 mm Hg in vitro. While arteries fromboth control and SAH animals constricted to increased intravascularpressure, there were significant differences in the characteristics ofthese pressure-induced responses between groups. Notably,pressure-induced constriction was approximately twice as great inarteries from SAH animals (FIG. 1). In addition, there was a fundamentaldifference in how these small diameter arteries from SAH animalsresponded to L-type VDCC antagonists (inhibitors). In arteries fromcontrol animals, pressure-induced constriction at 100 mmHg was abolishedby diltiazem (50 μmol/L), an L-type VDCC antagonist (FIG. 1A). However,in marked contrast to arteries from healthy animals, pressure-inducedconstriction of cerebral arteries from SAH animals was partiallyresistant to a combination of diltiazem (50 μmol/L) and nisoldipine (1μmol/L). In arteries from SAH animals, the constriction resistant toL-type VDCC antagonists, representing approximately 20% of the totalconstriction, was reversed by removal of extracellular Ca²⁺ from thephysiological saline solution (0 Ca²⁺ PSS) (FIG. 1B and FIG. 1C). Thesedata suggest an additional Ca²⁺ entry pathway resistant to antagonistsof L-type VDCCs emerges in cerebral arteries following SAH andcontributes to enhanced pressure-induced constriction.

Example 2 Enhanced VDCC Currents with Distinct Biophysical PropertiesFollowing SAH

To further explore the contribution of VDCCs to enhanced cerebral arteryconstriction following SAH, conventional whole-cell patch clampelectrophysiology was performed on freshly isolated cerebral arterymyocytes. No gross morphological distinctions were apparent betweenmyocytes from control and SAH animals. Cell capacitance, an index ofcell membrane surface area, was similar between the two groups (control:12.6±0.3 pF, n=252; SAH: 12.9±0.3 pF, n=315). Using 10 mmol/L Ba²⁺ as acharge carrier, depolarizing voltage steps from a holding potential of−80 mV elicited greater inward membrane currents in myocytes isolatedfrom SAH animals (FIG. 2A and FIG. 2B). Membrane currents from bothcontrol and SAH myocytes exhibited a “V-shaped” current-voltagerelationship, with peak current at +20 mV (FIG. 2C). Current density at+20 mV was markedly enhanced (≈50%) in myocytes from SAH (−12.8±1.5pA/pF) versus control (−8.3±1.3 pA/pF) animals. The voltage forhalf-maximal activation (V_(0.5,act)) obtained from Boltzmann fit oftail currents was similar between myocytes isolated from control animals(0.8±0.7 mV) and SAH animals (−2.3±0.6 mV), consistent with theactivation of high voltage-activated channels, but not lowvoltage-activated channels, in both cell types (FIG. 2D). To determinewhether enhanced VDCC currents in cerebral artery myocytes from SAHanimals had inactivation properties distinct from the L-type VDCCs inmyocytes of control animals, VDCC currents were measured in isolatedmonocytes from each group. The voltage for half-maximal steady-stateinactivation (V_(0.5,inact)) was shifted by about −15 mV in SAH myocytes(FIG. 3A). In addition, membrane currents from SAH myocytes exhibited amore rapid inactivation. Membrane current decay from myocytes of bothcontrol and SAH animals were best fit to a double exponential decay.Time constants for fast inactivation (τ₁) were decreased by 40-50% atvoltages between +10 mV and +30 mV in SAH compared to control myocytes(FIG. 3B). Time constants for slow inactivation (τ₂) were notsignificantly different between groups (FIG. 3C). Further, τ₁ made agreater contribution to current decay in cerebral artery myocytesisolated from SAH compared to control animals (FIG. 3D). These datademonstrated a fundamental change in the properties of VDCC currents,suggesting the possibility that a second, more rapidly inactivating,high voltage-activated Ca²⁺ channel (e.g. R-type) contributed toenhanced VDCC currents in cerebral artery myocytes following SAH.

Example 3 SNX-482-Sensitive VDCC Currents Emerge in Cerebral ArteryMyocytes Following SAH

To examine whether pharmacological agents that specifically blockvarious VDCC subtypes differentially impact currents from control andSAH myocytes, membrane potential was measured in the presence andabsence of drug compound. Consistent with the functional data shown inFIG. 1, the L-type VDCC antagonist diltiazem was a less effectiveinhibitor of membrane currents in cerebral artery myocytes isolated fromSAH animals. While the highest concentration of diltiazem (1000 μmol/L)used in this study completely blocked currents from control myocytes,approximately 20% of the current in SAH myocytes was resistant to thisL-type VDCC antagonist (FIGS. 4A and 4B). The current-voltagerelationship of the diltiazem-resistant current was consistent with highvoltage-activated VDCCs and similar to membrane currents from controland SAH animals in the absence of diltiazem (FIG. 4C). Thediltiazem-resistant component of VDCC currents present in SAH myocytesexhibited rapid inactivation kinetics (τ₁=10.5±1.0 ms at +20 mV, n=10).Excluding the diltiazem-resistant component, VDCC currents from SAHmyocytes were also less sensitive to diltiazem (K_(i)=99.5±10.4 μmol/L)compared to control (K_(i)=41.4±5.7 μmol/L) myocytes. In a similarmanner (i.e. excluding the resistant component), SAH myocytes exhibiteddecreased sensitivity to the dihydropyridine L-type Ca²⁺ channelantagonist, nifedipine (SAH: K_(i)=125.8±6.4 nmol/L versus control:K_(i)=55.6±3.9 nmol/L). VDCC currents resistant to high concentrationsof nifedipine (10 μmol/L) in SAH myocytes were abolished by cadmium (200μmol/L), a non-selective Ca²⁺ channel antagonist (n=4, data not shown).The selective antagonist of N-type Ca²⁺ channels, ω-Conotoxin GVIA(McCleskey E W, et al Proc Natl Acad Sci USA. 1987;84:4327-4331) (1μmol/L) and P/Q type Ca²⁺ channel antagonist, ω-Agatoxin IVA (Mintz I M,et al Nature. 1992;355:827-829.) (100 nmol/L) did not alter peak inwardcurrents at +20 mV in SAH myocytes (FIG. 4D). While antagonists of N-and P/Q-type channels were without effect, the R-type Ca²⁺ channelantagonist, SNX-482 (200 nmol/L) (Newcomb R, et al. Biochemistry.1998;37:15353-15362), reduced VDCC currents by approximately 30% inmyocytes from SAH, but had no effect on VDCC currents in myocytes fromcontrol animals (FIGS. 5A and 5B). Consistent with theseelectrophysiological data, SNX-482 dilated pressurized cerebral arteriesfrom SAH animals by approximately 30%, but had no significant effect onpressurized arteries from controls (FIGS. 5C and 5D). These data suggestthat the enhanced VDCC currents observed in cerebral artery myocytesfollowing SAH represent the expression of R-type Ca²⁺ channels.

Example 4 R-Type (Ca_(v) 2.3) VDCC Expression in Cerebral ArteryMyocytes Following SAH

RT-PCR was performed to examine whether mRNA of the pore-forming α₁subunit of the R-type VDCC (α_(1E) encoded by the gene Ca_(v) 2.3) waspresent in cerebral artery myocytes following SAH. Using α_(1E)-specificprimers generated from rabbit Ca_(v) 2.3 (see methods for sequence), theexpected 1.1 kb RT-PCR product of these primers was detected in cerebralarteries obtained from SAH animals, but not control animals (n=4) (FIG.6A). DNA sequencing verified that the product generated matched theexpected sequence of Ca_(v) 2.3. No product was detected in reactionsperformed in the absence of reverse transcriptase consistent with theabsence of genomic DNA contamination of the RNA samples. However, thepore-forming α₁ subunit of the L-type VDCC (α_(1C) encoded by the geneCa_(v) 1.2) was detected in both the control and SAH mRNA samples thatwere also used to examine Ca_(v) 2.3 expression (FIG. 6B). RT-PCR didnot detect Ca_(v) 2.3 mRNA in larger diameter basilar arteries obtainedfrom control or SAH animals.

Using confocal microscopy and the nuclear dye, YoYo®, to identifyvascular smooth muscle cells, a much greater immunofluorescent labelingof Ca_(v) 2.3 was detected in the smooth muscle of arteries from SAH,compared to control animals (FIG. 7). The enhanced fluorescence inarteries from SAH animals was abolished by either preadsorption of theprimary (Ca_(v) 2.3) antibody with a specific blocking peptide orexclusion of the Ca_(v) 2.3 antibody from the staining protocol(labeling with secondary antibody only).

These qualitative data provide the first evidence for R-type VDCCexpression in small diameter cerebral arteries. Further, these datasuggest that expression of pore-forming VDCC α₁ subunits is altered incerebral artery myocytes following subarachnoid hemorrhage withexpression of only Ca_(v) 1.2 in control animals, but with expression ofboth Ca_(v)1.2 and Ca_(v) 2.3 following subarachnoid hemorrhage.

Example 5 Oxyhemoglobin Reduces the Ability of Diltiazem to DilateCerebral Arteries

The impact of 1-5 day oxyhemoglobin exposure on K⁺-induced constrictionsand L-type VDCC function in small diameter cerebral arteries wasexamined. In freshly isolated arteries, increasing the concentration ofextracellular K⁺ to 60 mmol/L caused a constriction of 97±28 μm,representing 67±5.6% decrease in diameter (n=4). Diltiazem caused aconcentration-dependent reversal of the K⁺-induced constrictions. Infreshly isolated arteries, 1 mmol/L diltiazem reduced K⁺-inducedconstriction by 99.7±0.4 percent. Diltiazem at the same concentrationcaused a similar reversal of K⁺-induced constrictions in cerebralarteries organ cultured for a period of one or three days regardless ofwhether 10 μmol/L oxyhemoglobin was included in the media (FIGS. 8A, B).Under each of these conditions, diltiazem caused a complete reversal ofK⁺-induced constrictions with an IC₅₀ value of diltiazem forvasodilation of approximately 1 μmol/L (Table 1). After 5 days of organculture, a marked difference emerged between arteries maintained in thepresence and absence of oxyhemoglobin. In the absence of oxyhemoglobin,diltiazem completely reversed K⁺-induced constrictions in a mannersimilar to arteries that were either freshly isolated or organ culturedfor 1-3 days. However, with arteries organ cultured with oxyhemoglobinfor 5 days, K⁺-induced constrictions less sensitive to diltiazem asevidenced by a 10-fold increase in the IC₅₀ value (16.9±6.9 μmol/L). Inaddition, these arteries became partially resistant to diltiazem;approximately 20% of the K⁺-induced constrictions could not be reversedby the drug even at 1 mmol/L, which is almost 1000 fold higherconcentration of IC₅₀ for freshly isolated or 1-3 days cultured arteries(FIG. 8C). These data suggest another mechanism, in addition to L-typeVDCC, contributes to K⁺-induced constrictions of arteries exposed tooxyhemoglobin for 5 days. TABLE 1 EC₅₀ values of diltiazem treatment ofK⁺ induced constricted arteries at various time points. Both control andoxyhemoglobin treated samples are tabulated. Day 0 Day 1 Day 3 Day 5−Oxy Hb 1.02 ± 0.07 0.76 ± 0.07 0.78 ± 0.12  1.1 ± 0.10 +Oxy Hb 0.95 ±0.14 1.07 ± 0.06 16.9 ± 6.9

Example 6 R-Type VDCC Blocker SNX-482 Dilates Cerebral Arteries Exposedto Oxyhemoglobin

To investigate if R-type Ca²⁺ channels are functional in oxyhemoglobinexposed arteries, the arteries were treated with SNX-482, a blocker ofR-type Ca²⁺ channels. Arteries organ cultured in the presence ofoxyhemoglobin for 5 days were first constricted by 60 mM K⁺, exposed to1 mmol/L diltiazem, and then challenged with SNX-482 (220 nmol/L).Unlike arteries cultured in the absence of oxyhemoglobin (left column,FIG. 9), diltiazem could not fully reverse constrictions induced by 60mmol/L K⁺. However, this residual constriction observed in the presenceof diltiazem was effectively reversed by SNX-482 as shown in the rightcolumn in FIG. 9. To examine the possibility that the effect of SNX-482on vasodilation is dependent on the presence of diltiazem, arteriesconstricted with 60 mmol/L K⁺ were exposed to 220 nmol/L SNX-482 in theabsence of diltiazem. FIG. 10 shows that SNX-482 alone can dilatecerebral arteries in the absence of diltiazem. Again, the combination ofthese two drugs completely abolished the constriction. These resultsclearly indicate that functional R-type VDCC are present in smalldiameter cerebral arteries treated with oxyhemoglobin for 5 days, whichcontributes to K⁺-induced cerebral artery constriction.

Example 7 Oxyhemoglobin Enhances Gene Expression of R-Type VDCC Channels

The upregulation of R-type Ca²⁺ channels in cerebral arteries wasexamined by investigating RNA levels of CaV2.3, a pore-forming α1subunit of R-type VDCC, by RT-PCR. In the absence of oxyhemoglobin,CaV2.3 message was not detected in arteries cultured for 5 days (n=5).However, in arteries cultured with oxyhemoglobin, CaV2.3 mRNA was foundin 3 out of 5 preparations, although the intensity of these bands wererelatively faint (FIG. 11A). The low amplification of CaV2.3 is not dueto the low quantity or quality of RNA isolated from the organ culturedarteries, as GAPDH was clearly amplified in arteries organ cultured for5 days in the presence or absence of oxyhemoglobin. Nested PCR, a highlysensitive method to detect low levels of gene expression by utilizingtwo rounds of PCR, was used to confirm the selective expression ofCaV2.3. Here, the first round PCR product, as amplified using primerstargeting a region that is unique to CaV2.3, was employed as a templatefor the second round PCR. Using nested PCR, expression of R-type Ca²⁺channels after 5 days treatment with oxyhemoglobin was seen in five outof five preparations examined (FIG. 11B). In arteries organ cultured inthe absence of oxyhemoglobin, a PCR band corresponding to CaV2.3, wasobserved in one out of five samples. DNA analysis confirmed that thesequence of these bands perfectly matches the CaV2.3 sequence inpublished database (GenBank Accession number X 67855). These resultsdemonstrate that oxyhemoglobin is indeed able to induce R-type VDCC geneexpression.

The foregoing written specification is considered to be sufficient toenable one skilled in the art to practice the invention. The presentinvention is not to be limited in scope by examples provided, since theexamples are intended as a single illustration of one aspect of theinvention and other functionally equivalent embodiments are within thescope of the invention. Various modifications of the invention inaddition to those shown and described herein will become apparent tothose skilled in the art from the foregoing description and fall withinthe scope of the appended claims. The advantages and objects of theinvention are not necessarily encompassed by each embodiment of theinvention.

1. A method for treating cerebral vasospasm, comprising: administeringto a subject in need thereof an effective amount for treating cerebralvasospasm of a R-type voltage-dependent calcium channel inhibitor. 2.The method of claim 1 further comprising administering to the subject aL-type voltage-dependent calcium channel inhibitor.
 3. The method ofclaim 1, wherein the R-type voltage-dependent calcium channel inhibitoris administered within 96 hours after subarachnoid hemorrhage hasoccurred.
 4. The method of claim 1, wherein the R-type voltage-dependentcalcium channel inhibitor is administered within 1 week aftersubarachnoid hemorrhage has occurred.
 5. The method of claim 1, whereinthe R-type voltage-dependent calcium channel inhibitor is administeredduring surgery to treat subarachnoid hemorrhage.
 6. The method of claim1, wherein the R-type voltage-dependent calcium channel inhibitor is anactivity inhibitor.
 7. The method of claim 6, wherein the activityinhibitor is a small molecule.
 8. The method of claim 6, wherein theactivity inhibitor is SNX-482.
 9. The method of claim 1, wherein theR-type voltage-dependent calcium channel inhibitor is an expressioninhibitor.
 10. The method of claim 9, where the expression inhibitor isan antisense oligonucleotide or siRNA molecule.
 11. The method of claim1, wherein the R-type voltage-dependent calcium channel inhibitor isadministered orally.
 12. The method of claim 1, wherein the R-typevoltage-dependent calcium channel inhibitor is administeredintravenously.
 13. The method of claim 1, wherein the R-typevoltage-dependent calcium channel inhibitor is administered byintrathecal route.
 14. The method of claim 1, wherein the R-typevoltage-dependent calcium channel inhibitor is administered byintra-arterial route.
 15. The method of claim 1, wherein the R-typevoltage-dependent calcium channel inhibitor is administered by directbronchial application.
 16. The method of claim 1, wherein the R-typevoltage-dependent calcium channel inhibitor is administered by asuppository.
 17. The method of claim 1, wherein the R-typevoltage-dependent calcium channel inhibitor is administered duringsurgery.
 18. The method of claim 1, wherein the subject does not havesymptoms of cerebral vasospasm.
 19. The method of claim 1, wherein thesubject has symptoms of cerebral vasospasm.
 20. The method of claim 1,wherein the R-type voltage dependent calcium channel inhibitor isadministered by infusion into cerebrospinal fluid.
 21. The method ofclaim 20, wherein the R-type voltage dependent calcium channel inhibitoris an antisense oligonucleotide.
 22. The method of claim 2, wherein theL-type voltage dependent calcium channel inhibitor is an antisenseoligonucleotide.
 23. A method for treating cerebral vasospasm,comprising: administering to a subject in need thereof an effectiveamount for treating cerebral vasospasm of a L-type voltage-dependentcalcium channel inhibitor, wherein the L-type voltage dependent calciumchannel inhibitor is an antisense oligonucleotide of a L-type VDCCsmooth muscle splice variant.
 24. The method of claim 23, wherein theL-type VDCC smooth muscle splice variant is CaV1.2 Exon 9 region.
 25. Acomposition, comprising: an R-type voltage-dependent calcium channelinhibitor and an anti-cerebral vasospasm drug formulated with apharmaceutically-acceptable carrier. 26-35. (canceled)
 36. A kitcomprising: a container housing an R-type voltage-dependent calciumchannel inhibitor and instructions for administering the R-typevoltage-dependent calcium channel inhibitor to a subject a neurologicaldefect such as a subarachnoid hemorrhage or cerebral vasospasm.
 37. Acomposition, comprising: an R-type voltage-dependent calcium channelinhibitor and a pharmaceutically-acceptable carrier formulated as asuppository.
 38. A composition, comprising: an R-type voltage-dependentcalcium channel inhibitor and a pharmaceutically-acceptable carrierformulated for delivery to cerebrospinal fluid.